title: Antiplatelet Management for Coronary Heart Disease: Advances and Challenges.
abstract: Coronary heart disease (CHD) remains the leading cause of death in the USA. CHD accounts for 48 % of all cardiovascular mortality or approximately one of every seven deaths. Disruption of atherosclerotic plaques--usually by rupture or erosion--and superimposed thrombosis can result in acute coronary syndromes and sudden cardiac death. Silent plaque disruption may also occur and result in coronary plaque progression and ultimately the symptomatic manifestations of stable CHD. Antiplatelet agents remain the cornerstone therapy for acute thrombotic coronary syndromes and are essential for thromboprophylaxis against these events in patients with stable CHD. Antiplatelet drugs are also important adjunct therapies during percutaneous coronary intervention (PCI) as they mitigate equipment-associated thrombotic complications that are partially induced by iatrogenic plaque rupture by interventionalists during balloon angioplasty in the cardiac catheterization laboratory. Since the introduction of clopidogrel, there has been considerable development in this field with at least three novel P2Y12 antagonists approved by the Food and Drug Administration (FDA) over the past decade. Rapidly accumulating evidence is helping to guide the optimal duration of treatment with dual antiplatelet therapy after stenting, especially with the newer drug-eluting stents. More data are also emerging on the hazards and long-term safety of these agents. It is therefore prudent for clinicians to remain current on treatment options and recent advances in this area. We herein review current and emerging antiplatelet therapies and summarize their characteristics and indications of use as well as challenges and areas of ongoing research.
authors.affiliation: The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Cardiology 3C-320C, Houston, TX, 77030, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gillette
authors.affiliation: The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Cardiology 3C-320C, Houston, TX, 77030, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Morneau
authors.affiliation: The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Cardiology 3C-320C, Houston, TX, 77030, USA.
authors.forename: Vu
authors.initials: V
authors.lastname: Hoang
authors.affiliation: The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Cardiology 3C-320C, Houston, TX, 77030, USA.|Baylor College of Medicine, Houston, TX, USA.
authors.forename: Salim
authors.initials: S
authors.lastname: Virani
authors.affiliation: The Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd., Cardiology 3C-320C, Houston, TX, 77030, USA. jneid@bcm.edu.|Baylor College of Medicine, Houston, TX, USA. jneid@bcm.edu.
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000628:therapy*; D006801:Humans; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Acute coronary syndrome; Aggregation; Angina; Clinical trial; Coronary; Platelet; Thrombosis