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

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.

journal_name

Clin Cardiol

journal_title

Clinical cardiology

authors

Braunwald E,Angiolillo D,Bates E,Berger PB,Bhatt D,Cannon CP,Furman MI,Gurbel P,Michelson AD,Peterson E,Wiviott S

doi

10.1002/clc.20359

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

I28-35

issue

3 Suppl 1

eissn

0160-9289

issn

1932-8737

journal_volume

31

pub_type

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