Antiplatelet strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

Abstract

Abstract: Acute coronary syndrome (ACS) is a clinical syndrome caused by acute cardiac anoxemia, including unstable angina(UA) , non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction(STEMI).The main pathogenesis of ACS is platelet activation and thrombin formation associated with plaque rupture , eventually leading to thrombosis.Currently antiplatelet and anticoagulant therapies become the two important part of the antithrombotic treatment of patients with ACS. With the wide application of percutaneous coronary intervention therapy (PCI) in patients with ACS, preoperative safety and efficacy of antithrombotic drug are increasingly concerned. This article presents an overview on clinical trials evaluating the different aspects of antiplatelet therapy in patients undergoing PCI and discuss the emerging role of these agents in the contemporary era of early invasive coronary intervention.

Key words: Acute coronary syndrome, Percutaneous coronary intervention, Antiplatelet

CLC Number:

JIA Liang-Liang, KE Yong-sheng. Antiplatelet strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2012, 17(9): 1074-1080.

References

[1] Mehta SR, Bassand JP, Chrolavicius S, et al.Design and rationale of CURRENT-OASIS 7: a randomized,2× 2 factorial trial evaluation optimal dosing strategies for clopidogrel and aspirin in patients with ST and non-ST-elevation acute coronary syndromes managed with an early invasive strategy[J]. Am Heart J, 2008,156(6):1080-1088.
[2] Jolly SS, Pogue J, Haladyn K, et al.Effcets of asapirin dose on ischemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE Study[J]. Eur Heart J,2009,30(8):900-907.
[3] Mehta SR, Yusuf S, Peters RJ, et al.Effects of pretreatment with clopidrogel and aspririn followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study[J].Lancet,2001,358(9281):527-533.
[4] Steinhubl SR, Berger PB, Mann JT, et al.Early and sustained dula oral antiplatelet therapy following percutaneous coronary intervention[J].JAMA,2002,288(19):2411-2420.
[5] Patti G, Colonna G, Pasceri V, et al.Randomized trial of high loadingdose of clopidrogel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 Study[J]. Circulation,2005,111(16):2099-2106.
[6] Steinhubl SR, Berger PB, Brennan DM, et al.Optimal timing for the initiation of pretreatment with 300mg clopidrogel before percutaneous coronary intervention[J].J Am Coll Cardiol,2006,47(5):939-943.
[7] Di Sciascio G, Patti G, Pasceri V, et al.Clopidogrel reloading in patients undergoing percutaneous coronary intervention on chronic clopidogrel therapy: results of the ARMYDA-4 RELOAD (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) randomized trial[J]. Eur Heart J,2010,31(11):1337-1343.
[8] Kandzari DE, Berger PB, Kastrati A, et al.Influence of treatment duration with a 600-mg dose of clopidogrel before percutaneous coronary revascularization[J]. J Am Coll Cardiol, 2004,44(17):2133-2136.
[9] von Beckerath N, Taubert D, et al. Absorption,metabolism,and antiplatelet effects of 300-,600-,and 900-mg loading Doses of clopidogrel.ResultsoftheISAR-CHOICETrial[J].Circulation,2005,112(19):2946-2950.
[10] Wiviott SD, Braunwald E, McCabe C, et al. Prasugrel versus clopidrogel in patients with acute coronary syndromes[J]. N Engl J Med,2007,357(20):2001-2015.
[11] Montalescot G, Wiviott SD, Braunwald E, et al.Prasugrel compared with clopidrogel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind,randomized controlled trial[J]. Lancet,2009,373(9665):723-731.
[12] Kushner FG, Hand M, Smith SC Jr, et al.2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. JAMA,2009,54(23):2205-2241.
[13] Wallentin L, Becker RC, Budaj A, et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes[J]. N Engl J Med,2009,361(11):1045-1057.
[14] Gurbel PA,Bliden KP,Butler K,et al.Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study[J].Circulation,2009,120(25):2577-2585
[15] Bhatt DL, Lincoff AM, Gibson CM, et al.Intravenous platelet blockade with cangrelor during PCI[J]. N Engl J Med,2009,361(24):2330-2341.
[16] Harrington RA, Stone GW, McNulty S, et al. Platelet inhibition with cangrelor in patients undergoing PCI[J]. N Engl J Med,2009,361(24):2318-2329.
[17] Dominick J, Dominick J, Matthew J, et al.Bridging Antiplatelet Therapy With Cangrelor in Patients Undergoing Cardiac Surgery Bridging Antiplatelet Therapy With Cangrelor inPatients Undergoing Cardiac Surgery[J].JAMA,2012,307(3):265-274.
[18] Topol GJ, Califf RM, Weissman HF, et al.Randomized trial of coro- nary intervention with antibody against platelet glycoprotein IIb/IIIa integrin for reduction of clinical restenosis: results at 6 months. The EPIC investigators[J]. Lancet,1994,343(8902):1430-1435.
[19] Montalescot G, Antoniucci D, Kastrati A, et al.Abciximab in primary coronary stenting of ST-elevation myocardial infarction: a European meta-analysis on individual patients' data with long-term follow up[J].Eur Heart J,2007,28(4):443-449.
[20] O'Shea JC, Hafley GE, Greenberg S, et al. Platelet GPIIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial[J].JAMA,2001,285(19): 2468-2473.
[21] Van't Hof AW, Ten Berg J, Heetermans T, et al. Prehospital intiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME)2: a multicentre, double-blind, randomized controlled trial[J].Lancet,2008,372(9638):537-546.
[22] Valgimigli M, Campo G, Arcozzi C, et al.Comparison of angioplasty with infusion of tirofiban or abciximab and with implantationof sirolimus-eluting or uncoated stents for acute myocardioal infarction. The MULTISTRATEGY randomized trial[J].JAMA,2008,299(15):1788-1799.
[23] Labinaz M, Ho C, Banerjee S, et al.Meta-analysis of clinical efficacy and bleeding risk with intravenous glycoproteinIIb/IIIa antagonists for percutaneous coronary intervention[J].Can J Cardiol,2007,23(12):963-970.