Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention

Eugene Braunwald, Dominick Angiolillo, Eric Bates, Peter B. Berger, Deepak Bhatt, Christopher P. Cannon, Mark I. Furman, Paul Gurbel, Alan D. Michelson, Eric Peterson, Stephen Wiviott

Research output: Contribution to journalArticlepeer-review

Abstract

Despite the proven benefits of using antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI), a number of key questions remain to be answered. In recent years, clopidogrel dosing strategies among such patients have evolved considerably, with newer approaches involving loading doses prior to PCI and increases in the time interval and loading dosage in an effort to overcome variable responsiveness/hyporesponsiveness to platelet inhibition. Further, the role of glycoprotein (GP) IIb/IIIa antagonists in elective stenting continues to be defined, with recent evidence suggesting that most appropriate use of these agents is in high-risk patients with elevated troponin levels. There appears to be a relationship between the use of GP IIb/IIIa antagonists with clopidogrel loading and attenuation of early inflammatory and cardiac marker release. Strategies to minimize the chance of late stent thrombosis in patients who receive drug-eluting stents (DES) are also under intense investigation. Among some patients receiving sirolimus and paclitaxel DES, current standard long-term antiplatelet strategies may be insufficient. Patient nonadherence to treatment and premature discontinuation and underutilization of antiplatelet therapies by physicians remain important clinical problems with potentially dire consequences.

Original languageEnglish (US)
Pages (from-to)I28-I35
JournalClinical Cardiology
Volume31
Issue number3 SUUPL. 1
DOIs
StatePublished - Mar 1 2008

Keywords

  • Acute coronary syndromes<ischemic heart disease
  • Catheterization/diagnostic interventional<cardiac
  • Myocardial infarction<ischemic heart disease
  • Platelets
  • Thrombosis/hypercoagulable states

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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