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What is the role for improved long-term antiplatelet therapy after percutaneous coronary intervention?
Steven Steinhubl1, Peter Berger
1Division of Cardiology, University of North Carolina, CB#7075, 338 Burnett-Womack Building, Chapel Hill, NC 27599-7075, USA. steven_steinhubl@med.unc.edu
Insights
Dual antiplatelet therapy with clopidogrel and aspirin (ASA) may reduce cardiovascular events after percutaneous coronary intervention (PCI). Further research is needed to confirm the optimal duration for this therapy to prevent ischemic events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Coronary stent placement is preferred over balloon angioplasty for percutaneous coronary intervention (PCI) due to lower restenosis rates.
- Dual antiplatelet therapy with aspirin (ASA) and ticlopidine or clopidogrel is superior to aspirin monotherapy or aspirin with warfarin for reducing thrombotic events post-stenting.
- Intravenous glycoprotein IIb/IIIa inhibitors offer short-term protection against periprocedural thrombotic complications.
Purpose of the Study:
- To determine the duration of risk for recurrent thrombotic events after PCI with stenting.
- To identify the optimal strategy for preventing these recurrent thrombotic events.
Main Methods:
- Review of existing literature on antiplatelet therapy after PCI.
- Analysis of findings from clinical trials, including the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial.
Main Results:
- The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial demonstrated that long-term dual antiplatelet therapy (clopidogrel and aspirin) is more effective than aspirin alone in preventing major cardiovascular events in acute coronary syndrome patients undergoing PCI.
- Dual antiplatelet therapy with clopidogrel and aspirin shows promise for long-term protection, unlike shorter-acting agents.
Conclusions:
- Long-term dual oral antiplatelet therapy may play a significant role in preventing ischemic events in patients post-PCI.
- Further studies are required to establish the definitive role and optimal duration of long-term dual oral antiplatelet therapy for patients undergoing PCI.
Background:
Coronary stent placement has replaced balloon angioplasty as the percutaneous coronary intervention (PCI) method of choice, primarily because of its lower restenosis rate. Compared with aspirin (ASA) monotherapy or ASA plus warfarin, the ticlopidine and ASA combination is superior in reducing thrombotic events after stenting. Clopidogrel plus ASA appears to be at least as effective as ticlopidine and ASA. Intravenous glycoprotein IIb/IIIa inhibitors effectively prevent periprocedural thrombotic complications, but their short duration of action and parenteral dosing don't allow for long-term protection. This review aimed to answer how long after PCI with a stent patients are at risk for recurrent thrombotic events and what the optimal way to prevent them is.
Results:
Classically, ASA has been prescribed indefinitely, whereas adenosine diphosphate receptor antagonists have been discontinued after 2 to 4 weeks. However, the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial found that long-term dual antiplatelet therapy with clopidogrel and ASA was more effective than ASA alone in preventing major cardiovascular events in patients with acute coronary syndrome, including those treated with PCI.
Conclusion:
Results from additional ongoing studies are needed to clarify the role of long-term dual oral antiplatelet therapy in preventing ischemic events in patients who have undergone PCI.