Long-term Outcomes in Patients Undergoing Percutaneous Coronary Intervention with Drug-eluting Stents

Roberta Rossini; Giuseppe Musumeci; Alessandro Aprile; Orazio Valsecchi

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(1):49-61. 

In This Article

PCI & Oral Antiplatelet Therapy

Dual antiplatelet therapy with aspirin and thienopyridine is recommended for at least 12 months after DES implantation.[61] The role of antiplatelet therapy on stent thrombosis is evident, as it has been widely demonstrated that premature discontinuation of aspirin and/or clopidogrel severely impacts patient prognosis.[62] However, the optimal duration of dual antiplatelet therapy is still debatable as data are not consistent.[63–66] Indeed, patient compliance to the prescribed therapy is crucial, and the advent of generic clopidogrel might change the prescribing pattern and probably the duration of the thienopyridine therapy.

Despite the widespread use of clopidogrel in patients undergoing PCI with currently available thienopyridines, several important issues remain. Data from the Clopidogrel for the Reduction of Events During Observation (CREDO) trial suggest that most of the acute effect seen in reducing periprocedural events with clopidogrel was limited to patients who received the drug at least 6 h, and perhaps as long as 15 h, before the procedure.[67] In addition, a significant variability in the response to clopidogrel among healthy subjects and patients undergoing PCI has been observed, with some individuals having minimal inhibition of ADP-induced platelet aggregation.[68,69] This concept of clopidogrel resistance led to the concern that some patients may not be adequately protected from the intense platelet activation and aggregation that occur with PCI and are, therefore, at increased risk for thrombotic events. Because of these issues, an improved antiplatelet regimen to support PCI is desirable.

New antiplatelet agents, such as prasugrel and ticagrelor, have recently shown a significant superiority over clopidogrel in reducing ischemic events in patients with ACS subjected to PCI.[70–72] These new drugs might impact short- and long-term outcome in patients implanted with DES, by mitigating the risk of stent thrombosis.

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