| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Guest Access | Sign In via User Name/Password
|
|
|
|||||||
Guest Access | Sign In via User Name/Password |
|||||||||
Correspondence to: Jeffrey J. Popma, MD, Director, Interventional Cardiology, Brigham and Women’s Hospital, 75 Francis St, Tower 2–3A Room 311, Boston, MA 02115; e-mail: jpopma{at}partners.org
This chapter about antithrombotic therapy during percutaneous coronary intervention (PCI) is part of the seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients’ values may lead to different choices (for a full understanding of the grading, see Guyatt et al, CHEST 2004;126:179S–187S). Among the key recommendations in this chapter are the following: For patients undergoing PCI, we recommend pretreatment with aspirin, 75 to 325 mg (Grade 1A). For long-term treatment after PCI, we recommend aspirin, 75 to 162 mg/d (Grade 1A). For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, we recommend lower-dose aspirin, 75 to 100 mg/d (Grade 1C+). For patients who undergo stent placement, we recommend the combination of aspirin and a thienopyridine derivative (ticlopidine or clopidogrel) over systemic anticoagulation therapy (Grade 1A). We recommend clopidogrel over ticlopidine (Grade 1A). For all patients undergoing PCI, particularly those undergoing primary PCI, or those with refractory unstable angina or other high-risk features, we recommend use of a glycoprotein (GP) IIb-IIIa antagonist (abciximab or eptifibatide) [Grade 1A]. In patients undergoing PCI for ST-segment elevation MI, we recommend abciximab over eptifibatide (Grade 1B). In patients undergoing PCI, we recommend against the use of tirofiban as an alternative to abciximab (Grade 1A). In patients after uncomplicated PCI, we recommend against routine postprocedural infusion of heparin (Grade 1A). For patients undergoing PCI who are not treated with a GP IIb-IIIa antagonist, we recommend bivalirudin over heparin during PCI (Grade 1A). In PCI patients who are at low risk for complications, we recommend bivalirudin as an alternative to heparin as an adjunct to GP IIb-IIIa antagonists (Grade 1B). In PCI patients who are at high risk for bleeding, we recommend that bivalirudin over heparin as an adjunct to GP IIb-IIIa antagonists (Grade 1B). In patients who undergo PCI with no other indication for systemic anticoagulation therapy, we recommend against routine use of vitamin K antagonists after PCI (Grade 1A).
Key Words: anticoagulation • percutaneous coronary intervention • prophylaxis • stent • unstable angina
This article has been cited by other articles:
|
|
 |
|
  R. Dumaine, M. Borentain, O. Bertel, C. Bode, R. Gallo, H. D. White, J.-P. Collet, S. R. Steinhubl, and G. Montalescot Intravenous Low-Molecular-Weight Heparins Compared With Unfractionated Heparin in Percutaneous Coronary Intervention: Quantitative Review of Randomized Trials Arch Intern Med, December 10, 2007; 167(22): 2423 - 2430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Montalescot, G. Sideris, C. Meuleman, C. Bal-dit-Sollier, N. Lellouche, Ph. G. Steg, M. Slama, O. Milleron, J.-P. Collet, P. Henry, et al. A Randomized Comparison of High Clopidogrel Loading Doses in Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: The ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) Trial J. Am. Coll. Cardiol., September 5, 2006; 48(5): 931 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Kirtane, G. Piazza, S. A. Murphy, D. Budiu, D. A. Morrow, D. J. Cohen, E. Peterson, N. Lakkis, H. C. Herrmann, T. M. Palabrica, et al. Correlates of Bleeding Events Among Moderate- to High-Risk Patients Undergoing Percutaneous Coronary Intervention and Treated With Eptifibatide: Observations From the PROTECT-TIMI-30 Trial J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2374 - 2379. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Spahn, S. J. Howell, A. Delabays, and P.-G. Chassot Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. Br. J. Anaesth., June 1, 2006; 96(6): 675 - 677. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Makkar, R. L Wilensky, M. B. Julien, H. C Herrmann, and S. A Spinler Rash with Both Clopidogrel and Ticlopidine in Two Patients Following Percutaneous Coronary Intervention with Drug-Eluting Stents Ann. Pharmacother., June 1, 2006; 40(6): 1204 - 1207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Bates and J. I. Weitz Coagulation Assays Circulation, July 26, 2005; 112(4): e53 - e60. [Full Text] [PDF]
|
|
|
|
|
|
S. A Spinler, A. K Wittkowsky, E. A Nutescu, and M. A Smythe Anticoagulation Monitoring Part 2: Unfractionated Heparin and Low-Molecular-Weight Heparin Ann. Pharmacother., July 1, 2005; 39(7): 1275 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Cohen and E. M. Ohman Drug-Eluting Stents in Acute Myocardial Infarction: Is Science Catching Up With Practice? JAMA, May 4, 2005; 293(17): 2154 - 2156. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Leopold and E. M. Antman Dual Antiplatelet Therapy for Coronary Stenting: A Clear Path for a Research Agenda Circulation, March 8, 2005; 111(9): 1097 - 1099. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
