Developing drugs for use before, during and soon after percutaneous coronary intervention

Expert Opinion on Pharmacotherapy
Giuseppe GargiuloMarco Valgimigli

Abstract

Percutaneous coronary intervention (PCI) is a milestone for treating coronary artery disease (CAD). Antithrombotic therapy is essential to prevent ischemic complications, including the microvascular no-reflow, while minimizing bleeding events. This overview discusses available and developing drugs for PCI including anticoagulants, antiplatelets and treatment of no-reflow. For years unfractionated heparin (UFH) has been the unique anticoagulant to be used before and during PCI. Enoxaparin showed similar efficacy and safety, yet, based on recent trials, bivalirudin has been shown to have some benefits, particularly for patients with ST-segment elevation myocardial infarction (STEMI). The evidence concerning new anticoagulants is still preliminary, except for new oral anticoagulants, particularly rivaroxaban that showed intriguing findings and is currently under investigation. Dual antiplatelet therapy (DAPT) is the standard of care after PCI, but new developments have recently emerged. Indeed, ticagrelor and prasugrel are currently recommended over clopidogrel due to their significant reduction of ischemic events in acute coronary syndrome (ACS) whereas clopidogrel remains the choice in stable CAD. Among new agents, vorapaxar and...Continue Reading

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Citations

Jun 7, 2016·Expert Review of Cardiovascular Therapy·Massimo ManconeRoberto Diletti
Jun 20, 2016·JACC. Cardiovascular Interventions·Marco Valgimigli, Giuseppe Gargiulo
Jun 29, 2016·Revista Española De Cardiología·Giuseppe Gargiulo, Marco Valgimigli
Jan 18, 2017·Current Cardiology Reports·Sara AriottiMarco Valgimigli
Nov 12, 2020·European Heart Journal. Cardiovascular Pharmacotherapy·Leonardo De Luca, Marco Valgimigli

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