ABSTRACT
The recognition of the major contribution of platelet-mediated mechanisms to the pathogenesis
of thrombotic complications after coronary stenting has led to the development and
evaluation of different antiplatelet regimens. The combination of aspirin and adenosine
diphosphate antagonists such as ticlopidine and clopidogrel has solved the issue of
acute stent thrombosis. The timing and dose of dual oral antiplatelet therapy have,
however, changed over time with a shift from postintervention treatment to preintervention
treatment with a high loading dose of clopidogrel. Pretreatment with aspirin and clopidogrel
has been associated with a further 30% reduction in ischemic complications after coronary
intervention. Recent data have even shown that in case of optimal pretreatment with
such a dual oral antiplatelet therapy, glycoprotein IIb/IIIa antagonists are no longer
mandatory for elective coronary stenting and should be reserved only for high-risk
procedures or for acute coronary interventions.
KEYWORDS
Antiplatelet therapy - coronary stenting
