title: Direct oral anticoagulant use and stent thrombosis following an acute coronary syndrome: A potential new pharmacological option?
abstract: With the evolution of techniques and pharmacological strategies in percutaneous coronary intervention, significant advances have been made towards reducing the risk of in-stent restenosis and improving patient outcomes. However, in spite of these advances, stent thrombosis remains a deadly complication of stent implantation. The fundamental challenge in implementing a combined anticoagulant and antiplatelet strategy is balancing the risk of bleeding with the enhanced efficacy of therapy on both pathways. Results from the ATLAS ACS 2-TIMI 51 trial suggest that the addition of rivaroxaban 2.5mg twice daily to standard antiplatelet therapy may achieve this desired balance alongside careful patient selection. This review considers the clinical burden and pathology of stent thrombosis, oral antithrombotic strategies to reduce stent thrombosis, and what findings from recent trials could mean for the long-term management of patients with an acute coronary syndrome.
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Alberta, Canada. Electronic address: robert.welsh@albertahealthservices.ca.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Klinikum Ludwigshafen, 79, Bremser Street, 67063 Ludwigshafen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D014943:Global Health; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D062645:Percutaneous Coronary Intervention; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant; Anticoagulants; Antiplaquettaires; Antiplatelet; Intervention coronaire percutanée; Percutaneous coronary intervention; Stent thrombosis; Thrombose de stent