Triple Versus Dual Antiplatelet Therapy After Coronary Stenting

Lee, Seung Whan; Park, Seong Wook; Hong, Myeong Ki; Kim, Young Hak; Lee, Bong Ki; Song, Jong Min; Han, Ki Hoon; Lee, Cheol Whan; Kang, Duk Hyun; Song, Jae Kwan; Kim, Jae Joong; Park, Seung Jung

doi:10.1016/j.jacc.2005.07.048

Cited by 189 publications

(144 citation statements)

References 17 publications

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“…12 Triple therapy with aspirin and a thienopyridine (clopidogrel or ticlopidine) plus clilostrazol, a phosphodiesterase III inhibitor, has been reported to lower rates of stent thrombosis as compared to aspirin and thienopyridine alone (0.3% vs. 0.8%, respectively, OR 0.12). 13 In this report, we present a patient with acute stent thrombosis involving two different arteries in the setting of a recent ischemic stroke. The concurrence of multiple thrombo-embolic events led us to speculate that the patient may have systemically heightened platelet reactivity.…”

Section: Discussionmentioning

confidence: 99%

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Lee

Dunn

Marshall

et al. 2007

Clinical Cardiology

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SummaryDespite aggressive antiplatelet therapy in the setting of PCI, the incidence of acute stent thrombosis remains approximately 0.5-2%. We report a patient with simultaneous thrombosis of two drug-eluting coronary artery stents, suggesting a systemic thrombotic state. Evaluation by optical platelet aggregometry revealed clopidogrel resistance, which was overcome at a higher drug dose. We aim to highlight the potential utility of platelet function analysis to guide therapy for patients in whom inadequate antiplatelet therapy may have catastrophic clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Lee

Dunn

Marshall

et al. 2007

Clinical Cardiology

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“…The incidence was also within the same range (0-2.0%) as in previous reports that included elective BMS and SES implantations. [10][11][12] In addition, there was no new onset of late stent thrombosis in either group between 30 and 300 days after primary PCI. In a recent pooled analysis including 10 randomized studies, Moreno,et al 12) demonstrated that drug-eluting stents did not increase the risk of stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Eluting Stents in Real-World Patients With ST-Segment Elevation Acute Myocardial Infarction

Zhang

Qian

et al. 2007

Int. Heart J.

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SUMMARYRecently, the use of sirolimus-eluting stents (SES) has been demonstrated to significantly reduce the rate of adverse events among selected patients with ST-segment elevation acute myocardial infarction (STEMI). We present real-world experience from a single center registry evaluating the safety and efficacy of primary percutaneous coronary intervention (PCI) in unselected patients with STEMI using SES. Clinical outcome at 300-day follow-up in two cohorts of 225 consecutive patients who underwent bare metal stent (BMS) (January 2004 -February 2005, n = 123) or SES (March 2005 -December 2006, n = 102) implantation was examined. The primary endpoint was a composite of major adverse cardiovascular events (MACE: death, nonfatal reinfarction, and target vessel revascularization [TVR]). The incidence of short-term MACE was similar between the SES group and BMS group (30-day rate of MACE: 4.9% versus 8.9%, P = 0.30). Angiographically documented stent thrombosis within 30 days after primary PCI was not diagnosed in any patient in the SES group and occurred in 1 patient treated with BMS (0 versus 0.8%, P = 1.0). At 300 days, SES implantation significantly reduced the incidence of MACE (7.8% versus 22.8%, hazard ratio [HR] 0.32 [95% confidence interval (CI) 0.15 to 0.71], P = 0.005), mainly due to a marked reduction in the risk of TVR (1.0% versus 17.1%, HR 0.05 [95% CI 0.01 to 0.39], P < 0.001). There was no new onset of documented stent thrombosis between 30 and 300 days in either group. Thus, this real-world registry confirmed the safety and efficacy of SES with remarkably lower rates of TVR and MACE in the setting of primary PCI for unselected patients with STEMI in a real-world scenario. (Int Heart J 2007; 48: 303-311) Key words: Sirolimus-eluting stent, Acute myocardial infarction, Primary percutaneous coronary intervention NUMEROUS clinical trials have demonstrated that sirolimus-eluting stents (SES) greatly reduced in-stent restenosis and target vessel revascularization (TVR) compared with traditional bare metal stents (BMS) in relatively stable patients.

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“…This combination has been shown to be both effective and safe, with particular benefits noted in patients with diabetes. 2,32 However, the use of 3 antiplatelet agents has not been described in the neurointerventional literature. In addition to modifications to the traditional aspirin and P2Y12 inhibitor combination, single-drug therapies such as the GP-IIb/IIIa inhibitors abciximab and tirofiban have been described.…”

Section: Pharmacology Of Antiplatelet Medicationsmentioning

confidence: 99%

Platelet testing in flow diversion: a review of the evidence

Taylor

Dickerson

Dambrino

et al. 2017

Neurosurgical Focus

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OBJECTIVEAlthough the use of dual antiplatelet therapy with flow diversion is recommended and commonplace, the testing of platelet inhibition is more controversial.METHODSThe authors reviewed the medical literature to establish and describe the physiology of platelet adhesion, the pharmacology of antiplatelet medications, and the mechanisms of the available platelet function tests. Additionally, they present a review of the pertinent neurointerventional and interventional cardiology literature.RESULTSCompeting reports in the neurointerventional literature argue for and against the use of routine platelet function testing, with adjustments to the dosage or medications based on the results. The interventional cardiology literature has also wrestled with this dilemma after percutaneous coronary interventions, with conflicting reports of the benefits of platelet function testing.CONCLUSIONSDespite its prevalence, the benefits of platelet function testing prior to flow diversion are unproven. This practice will likely remain controversial until the level of evidence improves through more rigorous testing and reporting.

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Triple Versus Dual Antiplatelet Therapy After Coronary Stenting

Cited by 189 publications

References 17 publications

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

A case report of simultaneous thrombosis of two coronary artery stents in association with clopidogrel resistance

Sirolimus-Eluting Stents in Real-World Patients With ST-Segment Elevation Acute Myocardial Infarction

Platelet testing in flow diversion: a review of the evidence

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