Advertisement

Journal of Thrombosis and Thrombolysis

, Volume 2, Issue 1, pp 21–28 | Cite as

Antithrombotic therapy during percutaneous coronary intervention

  • Robert A. Harrington
Frontiers in Thrombocardiology

Abstract

Ischemic complications of percutaneous coronary intervention occur commonly and are among the major limitations of the procedure. Both platelets and thrombin play an essential role in the response to the arterial injury that follows coronary intervention and in the pathophysiology of the ischemic complications of the procedure. Aspirin and heparin are essential treatments for the patient undergoing coronary intervention. Novel thrombin and platelet inhibitors are being developed that may be useful for improving both acute and long-term clinical outcomes of percutaneous coronary intervention.

Key words

anticoagulants antiplatelets percutaneous transluminal coronary angioplasty 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Califf RM, Fortin DF, Frid DJ, et al. Restenosis after coronary angioplasty: An overview.J Am Coll Cardiol 1991;17:2B-13B.Google Scholar
  2. 2.
    Muhlestein JB, Zidar JP, Jackman JD. Vascular biology of restenosis: An overview. In: Roubin GS, Califf RM, O'Neill WW, Phillips HR, Stack RS, eds.Interventional Cardiovascular Medicine: Principles and Practice. New York: Churchill Livingstone, 1994.Google Scholar
  3. 3.
    de Feyter PJ, van den Brand M, Laarman GJ, van Domburg, Serruys PW, Suryapranata H. Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up.Circulation 1991;83:927–936.Google Scholar
  4. 4.
    Lincoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ. Abrupt vessel closure complicating coronary angioplasty: Clinical, angiographic and therapeutic profile.J Am Coll Cardiol 1992;19:926–935.Google Scholar
  5. 5.
    Detre KM, Holmes DR Jr, Holubkov R, et al. Incidence and consequences of periprocedural occlusion. The 1985–1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.Circulation 1990;82:739–750.Google Scholar
  6. 6.
    Scott NA, Weintraub WS, Carlin SF, et al. Recent changes in the management and outcome of acute closure after percutaneous transluminal coronary angioplasty.Am J Cardiol 1993;71:1159–1163.Google Scholar
  7. 7.
    Berdan LG, Holmes DR, Davidson-Ray L, et al. Economic impact of abrupt closure following percutaneous intervention: The CAVEAT experience.J Am Coll Cardiol 1994;23(Suppl):434A.Google Scholar
  8. 8.
    Steele PM, Chesebro JH, Stanson AW, et al. Balloon angioplasty: Natural history of the pathophysiological response to injury in a pig model.Cir Res 1985;57:105–112.Google Scholar
  9. 9.
    Schwartz L, Bourassa MG, Lesperance J, et al. Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty.N Engl J Med 1988;318:1714–1719.Google Scholar
  10. 10.
    Barnathan ES, Schwartz JS, Taylor L, et al. Aspirin and dipyridamole in the prevention of acute coronary thrombosis complicating coronary angioplasty.Circulation 1987;76:125–134.Google Scholar
  11. 11.
    White CW, Chaitman B, Knudtson ML, Knudtwon ML, Chisholm RJ and the Ticlopidine Study Group. Antiplatelet agents are effective in reducing the acute ischemic complications of angioplasty but do not prevent restenosis: Results from the ticlopidine trial.Cor Art Dis 1991;2:757–767.Google Scholar
  12. 12.
    Bengston JR, Wilson JS. Intervention in unstable angina. In: Roubin GS, Califf RM, O'Neill WW, Phillips HR, Stack RS, eds.Interventional Cardiovascular Medicine: Principles and Practice. New York: Churchill Livingstone, 1994.Google Scholar
  13. 13.
    Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (Part two).N Engl J Med 1992;326:310–318.Google Scholar
  14. 14.
    Laskey MA, Deutsch E, Barnathan E, Laskey W. Influence of heparin therapy on percutaneous transluminal coronary angioplasty outcome in unstable angina pectoris.Am J Cardiol 1990;65:1425–1429.Google Scholar
  15. 15.
    Myler RK, Shaw RE, Stertzer SH. Unstable angina and coronary angioplasty.Circulation 1990;82(Suppl II):II88–95.Google Scholar
  16. 16.
    Hettleman BD, Aplin RL, Sullivan PR, et al. Three days of heparin pretreatment reduces major complications of coronary angioplasty in patients with unstable angina.J Am Coll Cardiol 1990;15(Suppl):154A.Google Scholar
  17. 17.
    Ferguson JJ, Dougherty KG, Gaos CM, Bush HS, Marsh KC, Leachman DR. Relation between procedural activated coagulation time and outcome after percutaneous transluminal coronary angioplasty.J Am Coll Cardiol 1994;23:1061–1065.Google Scholar
  18. 18.
    Nairns CR, Hillegass WG, Nelson CL, et al. Activated clotting time predicts abrupt closure risk during angioplasty.J Am Coll Cardiol 1994;23(Suppl):470A.Google Scholar
  19. 19.
    Harrington RA, Leimberer JD, Berdan L, Topol EJ, Califf RM for the CAVEAT Investigators. The ACT index: A method for stratifying likelihood of success and risk of acute complications in coronary intervention.Circulation 1993;88(Suppl):I-208.Google Scholar
  20. 20.
    Ellis SG, Roubin GS, Wilentz J, Douglas JS, King SB. Effect of 18–24 hour heparin administration for prevention of restenosis after uncomplicated coronary angioplasty.Am Heart J 1989;117:777–782.Google Scholar
  21. 21.
    Friedman HZ, Cragg DR, Glazier SM, et al. Randomized prospective evaluation of prolonged versus abbreviated intravenous heparin therapy after coronary angioplasty.J Am Coll Cardiol 1994;24:1214–1219.Google Scholar
  22. 22.
    Becker RC, Cannon CP. Hirudin: Its biology and clinical use.J Thromb Thromboly 1994;1:7–16.Google Scholar
  23. 23.
    Weitz JI, Hudoba M, Massel D, Maraganore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors.J Clin Invest 1990;86:385–391.Google Scholar
  24. 24.
    van den Bos AA, Deckers JW, Heyndrick GR, et al. Safety and efficacy of recombinant hirudin (CGP 39 393) versus heparin in patients with stable angina undergoing coronary angioplasty.Circulation 1993;88:2058–2066.Google Scholar
  25. 25.
    Serruys PW. Thrombin inhibition to prevent restenosis after PTCA: the HELVETICA study. Presented at the Joint XIIth World Congress and XVIth Congress of the European Society of Cardiology, September 10–14, 1994, Berlin, German.Google Scholar
  26. 26.
    Ogilby JD, Kopelman HA, Klein LW, Agarwal JB. Adequate heparinization during PTCA: Assessment using activated clotting times.Cathet Cardiovasc Diagn 1989;18:206–209.Google Scholar
  27. 27.
    Maraganore JM, Bourdon P, Jablonski J, Ramachandran KL, Fenton JW. Design and characterization of hirulogs: A novel class of bivalent peptide inhibitors of thrombin.Biochemistry 1990;29:7095–7101.Google Scholar
  28. 28.
    Topol EJ, Bonan R, Jewitt D, et al. Use of a direct antithrombin, hirulog, in place of heparin during coronary angioplasty.Circulation 1993;87:1622–1629.Google Scholar
  29. 29.
    Bittl JA. Preliminary results of the Hirulog Angioplasty Trial. Presented at the 67th Scientific Sessions of the American Heart Association, November 14–17, 1994, Dallas, Texas.Google Scholar
  30. 30.
    Phillips DR, Charo IF, Parise LV, Fitzerald LA. The platelet membrane glycoprotein IIb/IIIa complex.Blood 1988;71:831–843.Google Scholar
  31. 31.
    Coller BS. A new murine monoclonal antibody reports an activation-dependent change in the conformation and/or microenvironment of the platelet glycoprotein IIb/IIIa complex.J Clin Invest 1985;76:101–108.Google Scholar
  32. 32.
    Tcheng JE, Ellis SG, George BS, et al. Pharmacodynamics of chimeric glycoprotein IIb/IIIa integrin antiplatelet antibody Fab 7E3 in high-risk coronary angioplasty.Circulation 1994;90:1757–1764.Google Scholar
  33. 33.
    The Epic Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty.N Engl J Med 1994;330:956–961.Google Scholar
  34. 34.
    Topol EJ, Califf RM, Weisman HF, et al. Randomised trial of coronary intervention with antibody against platelet IIb/ IIIa integrin for reduction of clinical restenosis: Results at six months.Lancet 1994;343:881–886.Google Scholar
  35. 35.
    Scarborough RM, Naughton MA, Teng W, et al. Design of potent and specific integrin antagonists.J Biol Chem 1993;268:1066–1073.Google Scholar
  36. 36.
    Tcheng JE, Harrington RA, Kottke-Marchant K, et al. Initial clinical experience with the platelet glycoprotein IIb/IIIa integrin blocker Integrelin in elective coronary intervention.Circulation 1995, in press.Google Scholar
  37. 37.
    Harrington RA, Marchant K, Kleiman NS, et al. Immediate, reversible platelet aggregation inhibition in patients undergoing coronary angioplasty.J Am Coll Cardiol 1994;23(Suppl):106A.Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • Robert A. Harrington
    • 1
  1. 1.Division of CardiologyDuke University Medical CenterDurham

Personalised recommendations