title: Anticoagulation in coronary intervention.
abstract: Percutaneous coronary intervention (PCI) induces thrombin generation and is associated with the risk of acute, subacute, or long-term ischaemic events. Therefore, intravenous anticoagulation is recommended to minimize thrombotic complications. The intensity and duration of anticoagulation needed are dependent on the clinical presentation (elective PCI for stable coronary artery disease, PCI for non-ST elevation acute coronary syndromes, or primary PCI for ST-segment elevation myocardial infarction) and procedural features. As both ischaemic and periprocedural bleeding complications are associated with acute and long-term mortality, the optimal level of anticoagulation and the best agents are a matter of debate. Despite a number of limitations and the lack of large randomized clinical trials, unfractionated heparin (UFH) is still been used in the majority of interventions. Intravenous enoxaparin, a low-molecular-weight heparin, leads to a more predictable level of anticoagulation and has been compared with UFH in patients with elective PCI and primary PCI with favourable results. The direct thrombin inhibitor bivalirudin has been studied in numerous trials and consistently shown to reduce bleeding complications when compared with UFH with or without glycoprotein IIb/IIIa inhibitors. This review will summarize the current status of anticoagulation for PCI and the results of most recent trials and give recommendations for different clinical scenarios.
authors.affiliation: Klinikum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany zeymeru@klilu.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.affiliation: The Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: ACTION Study Group, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Montalescot
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D000991:Antithrombins; D003327:Coronary Disease; D006493:Heparin; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin
keywords: Anticoagulation; Percutaneous coronary intervention; Thrombin inhibition