The state of periprocedural antiplatelet therapy after recent trials

JACC. Cardiovascular Interventions
Nihar R Desai, Deepak L Bhatt

Abstract

The ability to mechanically dilate and treat stenoses in the coronary arteries opened a new chapter in cardiovascular medicine. Percutaneous coronary intervention (PCI) has been shown to improve outcomes among patients with acute coronary syndromes as well as improve symptoms among patients with stable coronary artery disease. Adjunctive antiplatelet therapy plays a critical role both in the periprocedural setting as well as in the long-term management of atherothrombosis. Over the past several years, clinical trials of novel compounds and treatment strategies have further refined our pharmacotherapeutic approach. Aspirin remains the cornerstone for antiplatelet therapy across the spectrum of ischemic heart disease. In contrast, studies of glycoprotein IIb/IIIa inhibitors suggest a more limited role, particularly when used in addition to contemporary dual antiplatelet therapy. Clopidogrel, the most widely used P2Y(12) adenosine diphosphate receptor blocker--although having demonstrated efficacy in patients with ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndrome, and stable coronary artery disease undergoing PCI--has several limitations, including delay in onset, variability in response,...Continue Reading

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