Platelet activation is central in the vascular response to percutaneous coronary intervention (PCI). In addition, patients with coronary artery disease (CAD), particularly those with an acute coronary syndrome (ACS), have pre-existing platelet hyperreactivity which together are among the factors that predispose to stent thrombosis (ST). Thus dual antiplatelet therapy (DAT), which consists of aspirin and a thienopyridine, forms the cornerstone of pharmacotherapy following PCI with the goal of reducing ST, as well as ischemic events related to the underlying CAD. Adherence to DAT, and the need for a longer duration of treatment, has become even more important for patients receiving drug-eluting stents (DES) as concerns have been raised regarding the increased risk of very late ST (> 1-year) with the current generation of stents.1 Table 1 summarizes the most recent guidelines on DAT following PCI which have been jointly published by the American College of Cardiology (ACC), American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI).2,3 Despite the routine use of clopidogrel, there is uncertainty about the optimal timing, dose and duration of thienopyridine therapy, and there is a lack of consensus on the management of patients requiring non-cardiac surgery or chronic anticoagulation while being treated with DAT.
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