Aspirin and Dipyridamole in the Prevention of Re-Stenosis after Percutaneous Transluminal Coronary Angioplasty

Abstract

To examine the role of antiplatelet therapy in the prevention of arterial restenosis after percutaneous transluminal coronary angioplasty (PTCA), we conducted a randomized, double-blind, placebo-controlled study in 376 patients. The active treatment consisted of an oral aspirin-dipyridamole combination (330 mg-75 mg) given three times daily, beginning 24 hours before PTCA. Eight hours before PTCA, the oral dipyridamole was replaced with intravenous dipyridamole at a dosage of 10 mg per hour for 24 hours, and oral aspirin was continued. Sixteen hours after PTCA, the initial combination was reinstituted. Treatment was continued in patients with a successfully dilated vessel until follow-up angiography four to seven months after PTCA--or earlier, if symptoms dictated. Of 249 patients who underwent follow-up angiography, 37.7 percent of patients receiving the active drug had restenosis in at least one segment, as compared with 38.6 percent of patients taking placebo (P not significant). The number of stenotic segments was virtually the same in the two groups. Among the 376 randomized patients, there were 16 periprocedural Q-wave myocardial infarctions--13 in the placebo group and 3 in the active-drug group (6.9 percent vs. 1.6 percent, P = 0.0113). Although the use of this antiplatelet regimen before and after PTCA did not reduce the six-month rate of restenosis after successful coronary angioplasty, it markedly reduced the incidence of transmural myocardial infarction during or soon after PTCA. Thus, the short-term use of antiplatelet agents in relation to PTCA can be recommended.

8-Iso-PGF 2α Induces β 2 -Integrin–Mediated Rapid Adhesion of Human Polymorphonuclear Neutrophils

“…Interestingly, despite standard aspirin and heparin therapy, leukocyte activation and platelet adherence still occur after coronary angioplasty. 32 In contrast, experimental data and preliminary clinical studies have suggested that antioxidants, such as vitamin E, may prevent restenosis after angioplasty. 33 Furthermore, in a large, double-blind, randomized trial, probucol, a well-known antioxidant, improved vascular remodeling after PTCA.…”

Comparison of Ticlopidine and Cilostazol for the Prevention of Restenosis after Percutaneous Transluminal Coronary Angioplasty.

“…Though the underlying processes have not yet been fully elucidated, a special role in promoting the migration and proliferation of smooth muscle cells has been advocated for adherent platelets and resulting mural thrombi. [3][4][5] While previous studies with antiplatelet and anticoagulant agents such as aspirin, 14) aspirin plus dipyridamole, 15) warfarin, 16) heparin, 17) thromboxane A 2 receptor antagonists, 18) and the thrombin inhibitor hirudin 19) did not demonstrate positive effects after PTCA, use of the glycoprotein IIb / IIIa antagonist blocking the final common pathway of platelet aggregation resulted in fewer early ischemic complications 20) and a lower frequency of clinical manifestations of restenosis. 21) However, no follow-up angiographic data are available.…”

Brief review: Coronary drug-eluting stents and anesthesia

“…Aspirin alone has little or no effect on angiographic or clinical restenosis, but longterm aspirin therapy is useful for secondary prevention of cardiovascular events. 23 However, lower doses of aspirin, 75-100 mg, are used in combination with other antithrombotic agents. This is because a higher dose of aspirin is associated with increased risk of bleeding when used along with clopidogrel, without any added benefit.…”