Antiplatelet therapy in the era of drug-eluting stents: current and future perspectives

Abstract

The use of drug-eluting stents (DESs) dramatically reduced in-stent restenosis. However, the increasing use of these stents has raised concern about their potential thrombogenicity. Indeed, the particularity of DES thrombosis compared with bare metal stent thrombosis is a high rate of late thrombosis. Antiplatelet therapy is efficient in preventing DES thrombosis. However, this therapy could be optimized and may be improved in the future. This article will review the mechanisms and the epidemiology of stent thrombosis. Then, we will summarize the antiplatelet therapeutic strategies used to prevent stent thrombosis and especially DES-associated thrombosis. Finally, we will present some data with regard to potential advantages and pitfalls in DES thrombosis prevention using novel antiplatelet agents currently under development, as well as future stent designs with improved healing properties.

Keywords::

• antiplatelet therapy
• drug-eluting stent
• stent thrombosis
• thienopyridine

Financial disclosure

Gregory Ducrocq is a recipient of a research grant from the Fédération Francaise de Cardiologie. Jean-Francois Tanguay is from the Department of Medicine, University of Montreal (Quebec, Canada) and is supported in research by the Fonds de la recherche en santé du Québec (FRSQ), the Heart and Stroke Foundation of Canada (HSF), the Canadian Institutes of Health Research (CIHR). He also receives industry grants from Abbott, Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers-Squibb, Eli Lilly, Estracure, Pfizer and Sanofi-Aventis.