Antithrombotic Therapy after Intracoronary Stenting

Abstract

Conventional percutaneous transluminal coronary angioplasty may result in complications such as abrupt closure and late restenosis. This has led to increased application of mechanical revascularization techniques including intracoronary stents. In the past, subacute thrombosis after intracoronary stenting mandated anticoagulation with warfarin for a minimum of 1 month, with aspirin (ASA) started before the procedure and continued indefinitely. New information suggests that high‐pressure balloon inflation, with or without intracoronary ultrasound guidance to ensure successful stent placement, may permit reduction in the antithrombotic regimen to ASA, continued indefinitely, and ticlopidine, continued for 1–3 months. However, the majority of trials supporting this practice are primarily small, nonrandomized, observational studies. One randomized study found a lower frequency of cardiac events, including thrombosis, as well as fewer bleeding complications with combined antiplatelet therapy with ticlopidine compared with anticoagulant therapy with phenprocoumon. Intracoronary stenting without anticoagulation would permit shorter hospitalization and lead to cost‐savings. This has led many cardiologists to administer ASA and ticlopidine without benefit of data from randomized, blinded clinical trials. Antithrombotic therapy after coronary artery stenting is in an evolutionary stage, and additional information regarding the safety and efficacy of ASA and ticlopidine is necessary.