The use of adjunctive pharmacologic therapy in the setting of coronary angioplasty has evolved in recent years with the introduction of new antithrombotics and better understanding of the pharmacologic properties of the drugs. This manuscript reviews the various antithrombotic agents currently in use and their impact on the outcomes of patients receiving them.
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References
1.
GruentzigA. Transluminal dilatation of coronary artery stenoses. Lancet1978;65:215–25.
2.
FaxonDPWeberVJHaudenschildCAcute effects of transluminal angioplasty in three experimental models of atherosclerosis. Arteriosclerosis1982;2:125–33.
3.
SteelePMChesebroJHStansonAWBalloon angioplasty: natural history of the pathophysiological response to injury in a pig model. Circ Res1985;57:105–12.
4.
DetreKMHolmesDRHolubkivRIncidence and consequences of periprocedural occlusion: the 1985–1986 National Heart, Lung and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation1990;82:739–50.
5.
De FeyterPJvan den BrandMJaarmanGAcute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty: frequency, prediction, clinical course, management and follow-up. Circulation1991;83:927–36.
6.
LincoffAMPopmaJJEllisSGAbrupt vessel closure complicating coronary angioplasty: clinical, angiographic and therapeutic profile. J Am Coll Cardiol1992;19:926–35.
7.
GruentzigARKingSBSchlumpfMSiegenthalerW. Long-term follow-up after percutaneous transluminal coronary angioplasty. N Engl J Med1987;316:1127–32.
8.
McBrideWLangeRHillisL. Restenosis after successful coronary angioplasty: pathophysiology and prevention. N Engl J Med1988;318:1734–7.
9.
NarinsCRHillegrassWBNelsonCLRelation between activated clotting time during angioplasty and abrupt closure. Circulation1996;93:667–71.
10.
LaskeyMALDeutschEHirshfeldJWInfluence of heparin therapy on PTCA outcome in patients with coronary arterial thrombus. Am J Cardiol1990;65:179–82.
11.
FergusonJJDoughertyKGGaosCMRelation between procedural activated clotting time and outcome after PTCA. J Am Coll Cardiol1994;23:1061–5.
12.
EllisSGRoubinGSWilentzJEffect of 18 to 24 hour heparin administration for prevention of restenosis after uncomplicated coronary angioplasty. Am Heart J1992;123:1445–51.
13.
FriedmanHZCraggDRGlazierSMRandomized prospective evaluation of prolonged versus abbreviated intravenous heparin therapy after coronary angioplasty. J Am Coll Cardiol1994;24:1214–9.
14.
van den BosAADeckersJWHeyndrckxGRSafety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty. Circulation1993;88:2058–66.
15.
TopolEJBinanRJewittDUse of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty. Circulation1993;87:1622–9.
16.
SerruysPWHerrmanJPRSimonRA comparison of hirudin with heparin in the prevention of restenosis after coronary angioplasty. N Engl J Med1995;333:757–63.
17.
GrangerCBMillerJMBovillEGRebound increase in thrombin generation and activity after cessation of intravenous heparin in patients with acute coronary syndromes. Circulation1995;91:1929–35.
18.
BittlJAStronyJBrinkerJATreatment with bivalirudin (hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. N Engl Med J1995;333:764–9.
19.
RothGJMajerusPW. The mechanism of the effect of aspirin on human platelets. J Clin Invest1975;56:624–32.
20.
BurchJWStanfordNMajerusPW. Inhibition of platelet prostaglandin synthetase by oral aspirin. J Clin Invest1979;61:314–9.
21.
SchwartzLBourassaMGLesperanceJAspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med1988;318:1718–9.
22.
WhiteCWChaitmanBLassarTAAntiplatelet agents are effective in reducing the immediate complications of PTCA: results of the ticlopidine multicenter trial [abstract]. Circulation1987;76(Suppl I):I–400.
23.
BarnathanESSchwartzJSTaylorLAspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty. Circulation1987;76:125–34.
24.
MufsonLBlackARoubinGA randomized trial of aspirin in PTCA: effect of high versus low dose aspirin on major complications and restenosis [abstract]. J Am Coll Cardiol1988;11;236A.
25.
Di MinnoGCerboneAMMattioliPLFunctionally thrombasthenic state in normal platelets following the administration of ticlopidine. J Clin Invest1985;75:328–38.
26.
MaffrandJPHerbertJM, Effect of clopidogrel and ticlopidine on the binding of [3H]-2 methyl-thio-ADP to rat platelets. Thromb Haemost1993;69:637.
27.
CattaneoMLombardiRBettegaDShear-induced platelet aggregation is potentiated by desmopressin and inhibited by ticlopidine. Arteriosclerosis1993;13:393–7.
28.
Dembinska-KiecAVirgoliniIRauschaFTiclopidine and platelet function in healthy volunteer. Thromb Res1992;65:559–70.
29.
HeptinstallSMayJAGlennJREffects of ticlopidine administered to healthy volunteers on platelet function in whole blood. Thromb Haemost1995;74:1310–5.
30.
DefreynGBernatADelebasseeDMaffrandJP. Pharmacology of ticlopidine: a review. Semin Thromb Hemost1989;15:159–66.
31.
HallPNakamuraSMaielloLA randomized comparison of combined ticlopidine and aspirin therapy alone after successful intravascular ultrasound-guided stent implantation. Circulation1996;93:215–22.
32.
SchomigANeumannFJKastratiAA randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents. N Engl Med J1996;334:1084–9.
33.
PopmaJJCollerBSOhmanEMAntithrombotic therapy in patients undergoing coronary angioplasty. Chest1995;108:486S–501S.
34.
GoodsCMLiuMWRoubinGSA cost analysis of coronary stenting without anticoagulation versus stenting with anticoagulation using warfarin. Am J Cardiol1996;78:334–6.
35.
CAPRIE Steering committee. A randomized blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events. Lancet1996;348:1329–39.
36.
FitzgeraldGA. Dipyridamole. N Engl J Med1987;316:1247–57.
37.
LemboNJBlackAJRRoubinGSEffect of pretreatment with aspirin versus aspirin plus dipyridamole on frequency and type of acute complications of percutaneous transluminal coronary angioplasty. Am J Cardiol1990;65:422–6.
38.
The EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high risk coronary angioplasty. N Engl J Med1994;330:956–61.
39.
TopolEJCaliffRMWeismanHFRandomized trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosis: results at 6 months. Lancet1994;343:881–6.
40.
LefkovitsJIvanhoeRAndersonKEffects of platelet glycoprotein IIb/IIIa receptor blockade by a chimeric monoclonal antibody (abciximab) on acute and six-month outcomes after percutaneous transluminal coronary angioplasty for acute myocardial infarction. EPIC Investigators. Am J Cardiol1996;77:1045–51.
41.
AguirreFVTopolEJFergusonJJBleeding complications with the chimeric antibody to platelet glycoprotein IIb/IIIa integrin in patients undergoing percutaneous coronary intervention. Circulation1995;91:2882–90.
42.
MoliternoDJCaliffRMAguirreFVEffect of platelet glycoprotein IIb/IIIa integrin blockade on activated clotting time during PTCA or directional atherectomy (The EPIC Trial). Am J Cardiol1995;75:559–62.
43.
FergusonJJ. EPILOG and CAPTURE trials halted because of positive interim results. Circulation1996;93:637.
44.
TchengJEHarringtonRAMarchantKKMulticenter, randomized, double-blind, placebo-controlled trial of the platelet integrin glycoprotein IIb/IIIa blocker integrelin in elective coronary intervention. Circulation1995;91:2151–7.
