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Antithrombotic therapy for elective percutaneous coronary intervention: General use

Authors
Donald Cutlip, MD
Thomas Levin, MD
Section Editor
Stephan Windecker, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

Percutaneous coronary intervention (PCI) disrupts the coronary endothelium, leading to the exposure of subendothelial tissue factors to blood. Intracoronary thrombosis may result during or soon after the procedure. In addition, metal (which is procoagulant) stents can trigger thrombus formation. Stent thrombosis can be a life-threatening event. (See "Coronary artery stent thrombosis: Clinical presentation and management" and "Coronary artery stent thrombosis: Incidence and risk factors".)

Aggressive antithrombotic therapy with aspirin, platelet P2Y12 receptor blockers, glycoprotein (GP) IIb/IIIa inhibitors, and parenteral anticoagulants is used to decrease the risk of early intracoronary thrombosis. Recommendations for the use of these agents in stable patients before and within the first few days of stent placement will be the focus of this topic. The studies supporting these recommendations are presented separately. (See "Antithrombotic therapy for elective percutaneous coronary intervention: Clinical studies".)

The discussion of the long-term use of aspirin and platelet P2Y12 receptor blockers to prevent late and very late stent thrombosis is found elsewhere. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients".)

The use of antithrombotic therapy in the setting of acute coronary syndromes (ACS) is discussed elsewhere. (See "Antiplatelet agents in acute ST elevation myocardial infarction" and "Antiplatelet agents in acute non-ST elevation acute coronary syndromes" and "Anticoagulant therapy in non-ST elevation acute coronary syndromes" and "Anticoagulant therapy in acute ST elevation myocardial infarction".)

OUR APPROACH

We prescribe antithrombotic therapy to stable patients undergoing elective PCI with stenting in the following sequential manner:

                       

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 03 00:00:00 GMT+00:00 2016.
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