Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention
Department of Pediatrics
Angioplasty, Balloon, Coronary; Blood Platelets; Drug Administration Schedule; Drug Therapy, Combination; Guideline Adherence; Humans; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Practice Guidelines as Topic; Stents; Thrombosis; Ticlopidine; Treatment Outcome
Hematology | Oncology | Pediatrics
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.
DOI of Published Version
Clin Cardiol. 2008 Mar;31(3 Suppl 1):I28-35. doi 10.1002/clc.20359
Braunwald, Eugene; Angiolillo, Dominick J.; Bates, Eric; Berger, Peter B.; Bhatt, Deepak; Cannon, Christopher P.; Furman, Mark I.; Gurbel, Paul A.; Michelson, Alan D.; Peterson, Eric D.; and Wiviott, Stephen D., "Clinical considerations with the use of antiplatelet therapy in patients undergoing percutaneous coronary intervention" (2008). Hematology/Oncology. 108.