Contemporary antiplatelet therapy in patients undergoing percutaneous coronary intervention

Abstract

The proper use of antiplatelet agents in the cardiac catheterization laboratory is important for ensuring optimal results in patients undergoing percutaneous revascularization. Understanding the mechanisms by which these drugs exerts their effects is important for both interventional and non-interventional cardiologists. The effects of these agents on platelet function can be assessed and monitored using a variety of commercially available laboratory assays but so far these tests have not been adopted in routine clinical practice. Currently, aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors are the primary types of antiplatelet drugs being utilized. The use of these drugs and of several newer antiplatelet drugs in the treatment of patients undergoing percutaneous revascularization in the cardiac catheterization laboratory will be discussed, especially in the light of the recently published guidelines.

Keywords::

• antiplatelet agents
• cyclopentyltriazolopyrimidines aspirin
• percutaneous intervention
• thienopyridines

Financial & competing interests disclosure

MJ Cowley has served on the speakers’ bureau of Eli-Lilly and Daichi-Sankyo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Platelets are a key component of hemostasis and coagulation.

• Antiplatelet agents are an important adjuvant of percutaneous intervention.

• The main categories are aspirin, and P2Y₁₂ receptor inhibitors and glycoprotein IIb/IIIa inhibitors.

• All agents have been shown to improve outcomes in patients undergoing percutaneous coronary intervention, but the relevance of aspirin and clopidogrel resistance remains unclear as does the role of glycoprotein IIb/IIIa inhibitors in percutaneous intervention.

• The optimal duration of antiplatelet therapy in patients receiving a drug-eluting stent is still a moving target.

• Choosing between antiplatelet agents and integrating newer antiplatelet agents in our therapeutic armamentarium will take more time.

Notes