Abstract
Stent thrombosis (ST) is a rare complication following coronary stenting; however given the associated serious consequences, in particular death and myocardial infarction, it remains a source of considerable concern for cardiologists. Although no differences have been found between drug-eluting stents (DES) and bare-metal stents (BMS) in terms of early ST, some studies have reported adverse outcomes associated with DES as compared to BMS at long-term follow-up. Delayed endothelial coverage of the stent struts, inflammation and local hypersensitivity due to the interaction between the drug and polymer coating have been characterized to be typical for DES compared to BMS and may prolong the window of vulnerability to ST. Consequently the recommended duration of dual antiplatelet therapy (DAT) was longer with DES than with BMS. Results from studies investigating the optimal duration of DAT remain inconclusive and the current recommendation seems to be that patients undergoing DES implantation should have DAT for at least 6-12 months. Our treatment strategy requires more detailed analysis and should improve as we understand more about the impact of the newer generation DES and variability in antiplatelet therapy response, in addition to the effects of novel therapeutic agents and the availability of more data on the optimum duration of DAT.
Keywords: Coronary, angioplasty, drug-eluting stent, thrombosis, antiplatelet therapy, Stent Thrombosis, myocardial infarction, drug-eluting stents, cardiologists, bare-metal stents, restenosis, Gianturco-Roubin stent, aspirin, thienopyridine, ticlopidine, clopidogrel, sirolimus-eluting stent, myocardial, Basel Stent Kosten Effektivitäts, endothelialization, everolimus-eluting stent, phosphorylcholine, polivynilpyrrolidone, rapamycin-eluting stents, Biolimus-eluting stent, intra-vascular ultrasound, optical coherence tomography, MACE, SIRIUS trials, neointimal/plaque rupture, malapposition, acute coronary syndrome, light transmittance aggregometry
Current Pharmaceutical Design
Title: Stent Thrombosis and Duration of Dual Antiplatelet Therapy
Volume: 16 Issue: 36
Author(s): Alfonso Ielasi, Rasha Al-Lamee and Antonio Colombo
Affiliation:
Keywords: Coronary, angioplasty, drug-eluting stent, thrombosis, antiplatelet therapy, Stent Thrombosis, myocardial infarction, drug-eluting stents, cardiologists, bare-metal stents, restenosis, Gianturco-Roubin stent, aspirin, thienopyridine, ticlopidine, clopidogrel, sirolimus-eluting stent, myocardial, Basel Stent Kosten Effektivitäts, endothelialization, everolimus-eluting stent, phosphorylcholine, polivynilpyrrolidone, rapamycin-eluting stents, Biolimus-eluting stent, intra-vascular ultrasound, optical coherence tomography, MACE, SIRIUS trials, neointimal/plaque rupture, malapposition, acute coronary syndrome, light transmittance aggregometry
Abstract: Stent thrombosis (ST) is a rare complication following coronary stenting; however given the associated serious consequences, in particular death and myocardial infarction, it remains a source of considerable concern for cardiologists. Although no differences have been found between drug-eluting stents (DES) and bare-metal stents (BMS) in terms of early ST, some studies have reported adverse outcomes associated with DES as compared to BMS at long-term follow-up. Delayed endothelial coverage of the stent struts, inflammation and local hypersensitivity due to the interaction between the drug and polymer coating have been characterized to be typical for DES compared to BMS and may prolong the window of vulnerability to ST. Consequently the recommended duration of dual antiplatelet therapy (DAT) was longer with DES than with BMS. Results from studies investigating the optimal duration of DAT remain inconclusive and the current recommendation seems to be that patients undergoing DES implantation should have DAT for at least 6-12 months. Our treatment strategy requires more detailed analysis and should improve as we understand more about the impact of the newer generation DES and variability in antiplatelet therapy response, in addition to the effects of novel therapeutic agents and the availability of more data on the optimum duration of DAT.
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Cite this article as:
Ielasi Alfonso, Al-Lamee Rasha and Colombo Antonio, Stent Thrombosis and Duration of Dual Antiplatelet Therapy, Current Pharmaceutical Design 2010; 16 (36) . https://dx.doi.org/10.2174/138161210794454851
DOI https://dx.doi.org/10.2174/138161210794454851 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
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