Considerations in patients receiving oral antiplatelet therapy after acute coronary syndrome and percutaneous coronary intervention

American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
David S Roffman

Abstract

Adverse events that can occur in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI), and with the use of oral antiplatelet agents are discussed. Disruption of the vascular endothelium routinely occurs during PCI and stent placement, resulting in vascular injury. This injury can increase the risk of intracoronary thrombosis and subsequent ACS after PCI. Appropriate antiplatelet therapy reduces the risk of intracoronary thrombosis after PCI; however, health care providers should be aware of the possible limitations associated with specific antiplatelet agents and how to tailor therapy to improve outcomes. Platelet response after a clopidogrel loading dose is highly variable, and platelet hyporesponsiveness to clopidogrel may result in a variety of ischemic complications. A number of methods are available for assessing the antiplatelet effects of clopidogrel. However, none of these tests has been standardized as a measurement for clopidogrel responsiveness. Several polymorphic CYP enzymes are involved in the activation of clopidogrel, and genetic polymorphisms may affect the activity of these enzymes. Genetic variants, particularly the presence of the CYP2C19*2 allele, are associated wit...Continue Reading

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Citations

Apr 29, 2010·Circulation Journal : Official Journal of the Japanese Circulation Society·Shinya Goto

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