American Journal of Cardiovascular Drugs

, Volume 5, Issue 5, pp 307–318 | Cite as

Antiplatelet Agents in Patients Undergoing Percutaneous Coronary Intervention

How Many and How Much?
Review Article


Antiplatelet agents play a major role in patients undergoing percutaneous coronary intervention (PCI). Stent thrombosis and the demand for improved clinical outcomes have driven the need for aggressive antiplatelet and anticoagulant regimens and newer, more efficacious, therapies. The benefits of intravenous glycoprotein (GP) IIb/IIIa antagonists and clopidogrel in high-risk patients undergoing PCI appear complementary. In low- to intermediate-risk patients, clopidogrel pre-treatment and a maintenance dose of aspirin + clopidogrel for at least 1 year after PCI are supported by the data, although the optimal duration of clopidogrel treatment beyond 1 year remains hotly contested. The next generation of clinical trials will examine the benefits of antiplatelet and antithrombotic agents as adjunctive therapy with drug-eluting stents. A better understanding of our patients’ overall risk will add to procedural success and more durable outcomes.


  1. 1.
    Gruentzig AR. Translumination dilatation of coronary artery stenosis [letter]. Lancet 1978; I: 263.CrossRefGoogle Scholar
  2. 2.
    Gruentzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis. N Engl J Med 1979; 301: 61–8.CrossRefGoogle Scholar
  3. 3.
    O’Neill WW, Leon MB. Drug-eluting stents versus clinical benefit. Circulation 2003; 107: 3008–11.PubMedCrossRefGoogle Scholar
  4. 4.
    Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease: the Stent Restenosis Study investigators. N Engl J Med 1994; 331: 496–501.PubMedCrossRefGoogle Scholar
  5. 5.
    Savage MP, Douglas JS, Fischman DL, et al. Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts: the Saphenous Vein Do Novo Trial investigators. N Engl J Med 1997; 337(11): 740–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Erbel R, Haude M, Hopp HW, et al. Coronary-artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty: the Restenosis Stent Study Group. N Engl J Med 1998; 339: 1672–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Savage MP, Fischman DL, Rake R, et al. Efficacy of coronary stenting versus balloon angioplasty in small coronary arteries: the Stent Restenosis Study (STRESS) investigators. J Am Coll Cardiol 1998; 31: 307–11.PubMedCrossRefGoogle Scholar
  8. 8.
    Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction: the Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1999; 341(26): 1949–56.PubMedCrossRefGoogle Scholar
  9. 9.
    McNicol A, Israels SJ. Platelets and anti-platelet therapy. J Pharmacol Sci 2003; 93: 381–96.PubMedCrossRefGoogle Scholar
  10. 10.
    Patrono C, Bachmann F, Baigent C, et al. Expert consensus document on the use of antiplatelet agents: the Task Force on the Use of Antiplatelet Agents in Patients with Atherosclerotic Cardiovascular Disease of the European Society of Cardiology. Eur Heart J 2004; 25(2): 166–81.PubMedCrossRefGoogle Scholar
  11. 11.
    De Servi S, Hall P, Gaglione A, et al. Stent thrombosis: incidence and related factors in the Registro Impianto Stent Endocoronarico (RISE) registry. Catheter Cardiovasc Interv 1999; 46: 13–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith SC, Dove JT, Jacobs AK, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): Executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty). Endorsed by the Society for Cardiac Angiography and Interventions. Circulation 2001; 103(24): 3019–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: 2002. Summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 2002; 106(14): 1893–900.PubMedCrossRefGoogle Scholar
  14. 14.
    Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110(5): 588–636.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Neill WW, Grines CL. Surgery or stent? The gap continues to narrow. Lancet 2002; 360: 961–2.PubMedCrossRefGoogle Scholar
  16. 16.
    Collaborative overview of randomised trials of antiplatelet therapy: I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients: Antiplatelet Trialists’ Collaboration [published erratum appears in BMJ 1994; 308 (6943): 1540]. BMJ 1994; 308 (6921): 81–106.Google Scholar
  17. 17.
    Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: Second International Study of Infarct Survival (ISIS-2) Collaborative Group. Lancet 1988; II (8607): 349–60.Google Scholar
  18. 18.
    Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction and stroke in high-risk patients [published erratum appears in BMJ 2002; 324 (7330): 141]. BMJ 2002; 324(7329): 71–86.CrossRefGoogle Scholar
  19. 19.
    Topol EJ, Easton D, Harrington RA, et al. Randomized, double blind, placebo-controlled, international trial of the oral IIb/IIIa antagonist lotrafiban in coronary and cerebrovascular disease. Circulation 2003; 108: 399–404.PubMedCrossRefGoogle Scholar
  20. 20.
    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: 1714–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Savage MP, Goldberg S, Bove AA, et al. Effect of thromboxane A2 blockade on clinical outcome and restenosis after successful coronary angioplasty: Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART II). Circulation 1995; 92: 3194–200.PubMedCrossRefGoogle Scholar
  22. 22.
    Cipollone F, Patrignani P, Greco A, et al. Differential suppression of thromboxane biosynthesis by indobufen and aspirin in patients with unstable angina. Circulation 1997; 96: 1109–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Vejar M, Fragasso G, Hackett D, et al. Dissociation of platelet activation and spontaneous myocardial ischemia in unstable angina. Thromb Haemost 1990; 63: 163–8.PubMedGoogle Scholar
  24. 24.
    Eikelboom JW, Hirsh J, Weitz JI, et al. Aspirin-resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002; 105: 1650–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Gum PA, Kottke-Marchant K, Welsh PA, et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 2003; 41: 961–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Chen W-H, Lee P-Y, Ng W, et al. Aspirin resistance is associated with a high incidence of myonecrosis after non-urgent percutaneous coronary intervention despite clopidogrel treatment. J Am Coll Cardiol 2004; 43(6): 1122–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Bhatt DL. Aspirin resistance: more than just a laboratory curiosity. J Am Coll Cardiol 2004; 43(6): 1127–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Gollapudi RR, Teirstein PS, Stevenson DD, et al. Aspirin sensitivity implications for patients with coronary artery disease. JAMA 2004; 292: 2017–3023.CrossRefGoogle Scholar
  29. 29.
    Silberman S, Neukirch-Stoop C, Steg PG. Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol 2005; 95: 509–10.PubMedCrossRefGoogle Scholar
  30. 30.
    Leffkovits J, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa receptors in cardiovascular medicine. N Engl J Med 1995; 332: 1553–9.CrossRefGoogle Scholar
  31. 31.
    Bhatt DL, Topol EJ. Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA 2000; 284: 1549–58.PubMedCrossRefGoogle Scholar
  32. 32.
    Karvouni E, Katritsis DG, Ioannidis JP. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol 2003; 41: 26–32.PubMedCrossRefGoogle Scholar
  33. 33.
    Topol EJ, Ferguson JJ, Weisman HF, et al. Long-term protection from myocardial ischemic events in a randomized trial of brief integrin beta-3 blockade with percutaneous coronary intervention. JAMA 1997; 278: 479–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Topol EJ, Mark DB, Lincoff AM, et al. Outcomes at 1 year and economic implications of platelet glycoprotein IIb/IIIa blockade in patients undergoing coronary stenting. Lancet 1999; 354: 2019–24.PubMedCrossRefGoogle Scholar
  35. 35.
    Topol EJ, et al. Multi-year follow-up of abciximab therapy in three randomized, placebo-controlled trials of percutaneous coronary revascularization. Am J Med 2002; 113: 1–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Bhatt DL, Marso SP, Lincoff AM, et al. Abciximab reduces death in diabetics following percutaneous coronary intervention. J Am Coll Cardiol 2000; 35: 922–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Chew DP, Bhatt DL. Optimizing glycoprotein IIb/IIIa inhibition: lessons from recent randomized controlled trials. Intern Med J 2002; 32: 338–45.PubMedCrossRefGoogle Scholar
  38. 38.
    Lincoff AM, Califf RM, Anderson KM, et al. Evidence for prevention of death and myocardial infarction with platelet membrane glycoprotein IIb/IIIa receptor blockade by abciximab (c7E3 Fab) among patients with unstable angina undergoing percutaneous coronary revascularization. J Am Coll Cardiol 1997; 30: 149–56.PubMedCrossRefGoogle Scholar
  39. 39.
    O’shea JC, Hafley GE, Greenberg S, et al. Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: the ESPRIT trial. A randomized controlled trial. JAMA 2001; 285: 2468–73.PubMedCrossRefGoogle Scholar
  40. 40.
    Van Hout BA, Bownman L, Zelinger DJ, et al. Cost and effects in therapy for acute coronary syndromes. Eur Heart J 1998; 19 Suppl. D: D59–66.PubMedGoogle Scholar
  41. 41.
    Use of a monoclonal antibody directed against the glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty: the EPIC investigators. N Engl J Med 1994; 330 (14): 956–61.Google Scholar
  42. 42.
    Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary intervention: the EPILOG investigators. N Engl J Med 1997; 336 (24): 1689–96.Google Scholar
  43. 43.
    Randomized placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade: the EPISTENT investigators. Lancet 1998; 352 (9122): 87–92.Google Scholar
  44. 44.
    Topol EJ, Lincoff AM, Kereiakes DJ, et al. Multi-year follow-up of abciximab therapy in three randomized, placebo-controlled trials of percutaneous coronary revascularization. Am J Med 2002; 113: I–6.CrossRefGoogle Scholar
  45. 45.
    Jeremias A, Bhatt DL, Chew DP, et al. Safety of abciximab during percutaneous coronary intervention in patients with chronic renal insufficiency. Am J Cardiol 2002; 89: 1209–11.PubMedCrossRefGoogle Scholar
  46. 46.
    Randomized placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Integrilin to Minimise Platelet Aggregation and Coronary Thrombosis-II. Lancet 1997; 349 (9063): 1422–8.Google Scholar
  47. 47.
    The ESPRIT investigators. Novel dosing regimen of eptifibatide in planned coronary stenting implantation: a randomized, placebo-controlled trial [published erratum appears in Lancet 2001; 357 (9265): 1370]. Lancet 2000; 356(9247): 2037–44.CrossRefGoogle Scholar
  48. 48.
    Effects of platelets glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty: the RESTORE investigators. Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis. Circulation 1997; 96 (5): 1445–53.Google Scholar
  49. 49.
    Batchelor WB, Tolleson TR, Huang Y, et al. Randomized comparison of platelet inhibition with abciximab, tirofiban and eptifibatide during percutaneous coronary intervention in acute coronary syndromes: the COMPARE trial. Circulation 2002; 106: 1470–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Valgimigli M, Percoco G, Beriberi D, et al. The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: the ADVANCE Trial. J Am Coll Cardiol 2004; 44(1): 14–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes: the PURSUIT Trial investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med1998; 339 (7): 436–43.Google Scholar
  52. 52.
    A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina: Platelet Receptor Inhibition in ischemic Syndrome Management (PRISM) Study investigators. N Engl J Med 1998; 338 (21): 1498–505.Google Scholar
  53. 53.
    Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction: Platelet Receptor Inhibition in ischemic Syndrome Management in Patients Limited by Unstable Signs and symptoms (PRISM-PLUS) study investigators [published erratum appears in N Engl J Med 1998; 339 (6): 415]. N Engl J Med 1998; 338: 1488–97.Google Scholar
  54. 54.
    International, randomized, controlled trial of lamifiban (a platelet glycoprotein IIb/ IIIa inhibitor), heparin, or both in unstable angina: the PARAGON investigators. Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network. Circulation 1998; 97(24): 2386–95.CrossRefGoogle Scholar
  55. 55.
    Global Organization Network (PARAGON-B investigators). Randomized, placebo-controlled trial of titrated intravenous lamifiban for acute coronary syndromes. Circulation 2002; 105(3): 316–21.CrossRefGoogle Scholar
  56. 56.
    Simoons ML, The GUSTO-IV ACS investigators. Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularization: the GUSTO IV-ACS randomized trial. Lancet 2001; 357(9272): 1915–1924.PubMedCrossRefGoogle Scholar
  57. 57.
    Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomized clinical trials. Lancet 2002; 359: 189–98.PubMedCrossRefGoogle Scholar
  58. 58.
    Roffi M, Chew DP, Mukherjee D, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment elevation acute coronary syndromes. Circulation 2001; 104: 2767–71.PubMedCrossRefGoogle Scholar
  59. 59.
    Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study [published erratum appears in Lancet 1997; 350 (9079): 744]. Lancet 1997; 349 (9063): 1429–35.Google Scholar
  60. 60.
    Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med 1999; 340: 1623–9.PubMedCrossRefGoogle Scholar
  61. 61.
    Boersma E, Akkerhuis KM, Theroux P, et al. Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation 1999; 100(20): 2045–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Boden WE, O’Rourke RA, Crawford MH, et al. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy: Veterans Affairs Non Q-Wave Infarction Strategies in Hospital (VANQWISH) trial investigators [published erratum appears in N Engl J Med 1998; 339 (15): 1091]. N Engl J Med 1998; 338: 1785–92.PubMedCrossRefGoogle Scholar
  63. 63.
    Anderson HV, Cannon CP, Stone PH, et al. One-year results of the Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. J Am Coll Cardiol 1995; 26: 1643–50.PubMedCrossRefGoogle Scholar
  64. 64.
    Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomized multicentre study. Fragmin and fast Revascularization during InStability in Coronary artery disease investigators. Lancet 1999; 354 (9180): 708–15.Google Scholar
  65. 65.
    Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001; 344: 1879–87.PubMedCrossRefGoogle Scholar
  66. 66.
    Bhatt DL, Roe MT, Peterson ED, et al. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA 2004; 292: 2096–104.PubMedCrossRefGoogle Scholar
  67. 67.
    Lee DP, Herity NA, Hiatt BL, et al. Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary angioplasty improves angiographic outcomes. Circulation 2003; 107(11): 1497–501.PubMedCrossRefGoogle Scholar
  68. 68.
    Cutlip DE, Cove CJ, Irons D, et al. Emergency room administration of eptifibatide before primary angioplasty for ST elevation acute myocardial infarction and its effect on baseline coronary flow and procedure outcomes. Am J Cardiol 2001; 88: 62–4.CrossRefGoogle Scholar
  69. 69.
    Brener SJ, Barr LA, Burchenal JE, et al. Randomized, placebo controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction: ReoPro And Primary PTCA Organization and Randomized Trial (RAPPORT) investigators. Circulation 1998; 98(8): 734–41.PubMedCrossRefGoogle Scholar
  70. 70.
    Neumann FJ, Kastrani A, Schmitt C, et al. Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following myocardial infarction. J Am Coll Cardiol 2000; 35: 915–21.PubMedCrossRefGoogle Scholar
  71. 71.
    Montalescot G, Barragan P, Wittenberg O, et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001; 344(25): 1895–903.PubMedCrossRefGoogle Scholar
  72. 72.
    Stone GW, Grines CL, Cox DA, et al. Comparison of angioplasty with stenting, with or without abciximab in acute myocardial infarction. N Engl J Med 2002; 346(13): 957–66.PubMedCrossRefGoogle Scholar
  73. 73.
    Antoniucci D, Rodriguez A, Hempel A, et al. A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction. J Am Coll Cardiol 2003; 42: 1879–85.PubMedCrossRefGoogle Scholar
  74. 74.
    Topol EJ, Neumann FJ, Montalescot G. A preferred reperfusion strategy for acute myocardial infarction. J Am Coll Cardiol 2003; 42: 1886–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Knobner H, Savion N, Skenkman B, et al. Shear-induced platelet adhesion and aggregation on subendothelium are increased in diabetic patients. Thromb Res 1998; 90: 181–90.CrossRefGoogle Scholar
  76. 76.
    Iwase E, Tawata M, Aida K, et al. A cross-sectional evaluation of spontaneous platelet aggregation in relation to complications in patients with type II diabetes mellitus. Metabolism 1998; 47: 699–705.PubMedCrossRefGoogle Scholar
  77. 77.
    Tschoepe D, Roesen P, Kaufmann L, et al. Evidence for abnormal platelet glycoprotein expression in diabetes mellitus. Eur J Clin Invest 1990; 20: 166–70.PubMedCrossRefGoogle Scholar
  78. 78.
    Anderson HV, Shaw RE, Brindis RG, et al. A contemporary overview of percutaneous coronary interventions: the American College of Cardiology — National Cardiovascular Data Registry (ACC-NCDR). J Am Coll Cardiol 2002; 39: 1096–103.PubMedCrossRefGoogle Scholar
  79. 79.
    Smith SC, Faxon D, Cascio W, et al. Diabetes and cardiovascular disease writing group VI: revascularization in diabetic patients. Circulation 2002; 105: e165–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Mehilli J, Kastrati A, Schuhlen H, et al. Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel: the ISAR-SWEET investigators. Circulation 2004; 110: 3627–35.PubMedCrossRefGoogle Scholar
  81. 81.
    Hong MK, Mehran R, Dangas G, et al. Are we making progress with percutaneous saphenous vein graft treatment? A comparison of 1990 to 1994 and 1995 to 1998 results. J Am Coll Cardiol 2001; 38: 150–4.PubMedCrossRefGoogle Scholar
  82. 82.
    Mathew V, Grill D, Scott C, et al. The influence of abciximab use on clinical outcome after aortocoronary vein graft interventions. J Am Coll Cardiol 1999; 34: 1163–9.PubMedCrossRefGoogle Scholar
  83. 83.
    Roffi M, Mukherjee D, Chew DP, et al. Lack of benefit from intravenous platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment for percutaneous interventions of aortocoronary bypass grafts. Circulation 2002; 106: 3063–7.PubMedCrossRefGoogle Scholar
  84. 84.
    Topol EJ, Moliterno DJ, Herrmann HC, et al. Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization. N Engl J Med 2001; 344: 1888–94.PubMedCrossRefGoogle Scholar
  85. 85.
    Danzi GB, Sesana M, Capuano C, et al. Comparison in patients having primary coronary angioplasty of abciximab versus tirofiban on recovery of left ventricular function. Am J Cardiol 2004; 94(1): 35–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Valgimigli M, Percoco G, Cicchitelli G, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA 2005; 293(17): 2109–17.PubMedCrossRefGoogle Scholar
  87. 87.
    Lincoff AM, Bittl JA, Harrington RA, et al. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA 2003; 289(7): 853–63.PubMedCrossRefGoogle Scholar
  88. 88.
    Wong GC, Giugliano RP, Antman EM. Use of low-molecular weight heparins in the management of acute coronary syndromes and percutaneous coronary intervention. JAMA 2003; 289: 331–42.PubMedCrossRefGoogle Scholar
  89. 89.
    Ferguson JJ, Califf RM, Antman EM, et al. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST segment elevation acute coronary syndromes managed with an intended early invasive strategy: the SYNERGY trial investigators. JAMA 2004; 292: 45–54.PubMedCrossRefGoogle Scholar
  90. 90.
    Bittl JA, Strony J, Brinker JA, et al. Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina: Hirulog Angioplasty Study investigators. N Engl J Med 1995; 333: 764–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Lincoff AM, Kleiman NS, Kereiakes DJ, et al. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA 2004; 292(6): 696–703.PubMedCrossRefGoogle Scholar
  92. 92.
    Cohen DJ, Lavelle T, Chen H-L, et al. Cost-effectiveness of bivalirudin with provisional glycoprotein IIb/IIIa inhibition vs heparin and routine glycoprotein IIb/IIIa inhibition for contemporary PCI: results from the REPLACE II trial. Circulation 2003; 108 Suppl. IV: IV–570.Google Scholar
  93. 93.
    Millenium Pharmaceuticals, Inc. New data reveal clinical differences between INTEGRILIN® (eptifibatide) injection and bivalirudin: press release 2004 Nov 6 [online]. Available from URL: [Accessed 2005 Jul 6].
  94. 94.
    Stone GW, Bertrand M, Colombo A, et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J 2004; 148: 764–75.PubMedCrossRefGoogle Scholar
  95. 95.
    LeBauer cardiovascular research foundation. LeBauer research foundation enrolls first STEMI patients in HORIZONS trial [online]. Available from URL: [Accessed 2005 Jul 21].
  96. 96.
    Chew DP, Bhatt DL. Oral glycoprotein IIb/IIIa antagonists in coronary artery disease. Curr Cardiol Rep 2001; 3: 63–71.PubMedCrossRefGoogle Scholar
  97. 97.
    Chew DP, Bhatt DL, Sapp S, et al. Increased mortality with oral platelet glycoprotein IIb/IIIa antagonists: a meta-analysis of phase III multicenter randomized trials. Circulation 2001; 103: 201–6.PubMedCrossRefGoogle Scholar
  98. 98.
    O’Neill WW, Serruys P, Knudtson M, et al. The evaluation of oral xemilofiban in controlling thrombotic events (EXCITE): long term treatment with glycoprotein-receptor antagonist after percutaneous coronary revascularization. N Engl J Med 2000; 342: 1316–24.PubMedCrossRefGoogle Scholar
  99. 99.
    Leon MB, Baim DS, Popma JJ, et al. A clinical trial comparing three antithrombotic-drug regimens after coronary artery stenting: the Stent Anticoagulation Restenosis Study investigators. N Engl J Med 1998; 339: 1665–71.PubMedCrossRefGoogle Scholar
  100. 100.
    Steinhubl SR, Tan WA, Foody JM, et al. Incidence and clinical course of thrombotic thrombocytopenic purpura due to ticlopidine following coronary stenting: the Evaluation of Platelet IIb/IIIa Inhibitor for STENTing (EPISTENT) investigators. JAMA 1999; 281: 806–10.PubMedCrossRefGoogle Scholar
  101. 101.
    A randomized, blinded trial of Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE): CAPRIE Steering Committee. Lancet 1996; 348 (9038): 1329–1338.Google Scholar
  102. 102.
    Moshfegh K, Redondo M, Julmy F, et al. Antiplatelet effects of clopidogrel compared with aspirin after myocardial infarction: enhanced inhibitory effects of combination therapy. J Am Coll Cardiol 2000; 36: 699–705.PubMedCrossRefGoogle Scholar
  103. 103.
    Muller C, Buttner HJ, Petersen J, et al. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents. Circulation 2000; 101: 590–3.PubMedCrossRefGoogle Scholar
  104. 104.
    Bertrand ME, Rupprecht HJ, Urban P, et al. Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting: the CLopidogrel ASpirin Stent International Cooperative Study (CLASSICS). Circulation 2000; 102(6): 624–9.PubMedCrossRefGoogle Scholar
  105. 105.
    Taniuchi M, Kusz HI, Lasala JM. Randomized comparison of ticlopidine and clopidogrel after intracoronary stent implantation in a broad patient population. Circulation 2001; 104: 539–43.PubMedCrossRefGoogle Scholar
  106. 106.
    Calver AL, Blows LJ, Harmer S, et al. Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents. Am Heart J 2000; 140: 483–91.PubMedCrossRefGoogle Scholar
  107. 107.
    Mishkel GJ, Aguirre FV, Ligon RW, et al. Clopidogrel as adjunctive antiplatelet therapy during coronary stenting. J Am Coll Cardiol 1999; 34: 1884–90.PubMedCrossRefGoogle Scholar
  108. 108.
    Moussa I, Oetgen M, Roubin G, et al. Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation. Circulation 1999; 99: 2364–6.PubMedCrossRefGoogle Scholar
  109. 109.
    Berger PB, Bell MR, Rihal CS, et al. Clopidogrel versus ticlopidine after intracoronary stent placement. J Am Coll Cardiol 1999; 34: 1891–4.PubMedCrossRefGoogle Scholar
  110. 110.
    Plucinski DA, Scheltema K, Krusmark J, et al. A comparison of clopidogrel to ticlopidine therapy for the prevention of major adverse cardiac events at thirty days and six months following coronary stent implantation [abstract]. J Am Coll Cardiol 2000; 35: Suppl.: 67A.CrossRefGoogle Scholar
  111. 111.
    Dangas G, Mehran R, Abizaid A, et al. Combination therapy with aspirin plus ticlopidine for the prevention of subacute thrombosis after successful native coronary stenting. Am J Cardiol 2001; 87: 470–2.PubMedCrossRefGoogle Scholar
  112. 112.
    Allier PL, Aronow HD, Cura FA, et al. Short-term mortality lower with clopidogrel than ticlopidine following coronary artery stenting [abstract]. Am J Cardiol 2000; 35: Suppl.: 66A.Google Scholar
  113. 113.
    Bhatt DL, Bertrand ME, Berger PB, et al. Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting. J Am Coll Cardiol 2002; 39(1): 9–14.PubMedCrossRefGoogle Scholar
  114. 114.
    Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345: 494–502.PubMedCrossRefGoogle Scholar
  115. 115.
    Vivekananthan DP, Bhatt DL, Chew DP, et al. Clopidogrel pretreatment prior to percutaneous coronary intervention attenuates periprocedural rise of C-reactive protein. J Am Coll Cardiol 2003; 41: 1075–165.Google Scholar
  116. 116.
    Walter DH, Fichtlscherer S, Sellwig M, et al. Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation. J Am Coll Cardiol 2001; 37: 839–46.PubMedCrossRefGoogle Scholar
  117. 117.
    Chew DP, Bhatt DL, Robbins MA, et al. Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in percutaneous coronary intervention. Circulation 2001; 104: 992–7.PubMedCrossRefGoogle Scholar
  118. 118.
    Chew DP, Bhatt DL, Robbins MA, et al. Effect of clopidogrel added to aspirin before percutaneous coronary intervention on the risk associated with C-reactive protein. Am J Cardiol 2001; 88: 672–4.PubMedCrossRefGoogle Scholar
  119. 119.
    Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 2001; 358: 527–33.PubMedCrossRefGoogle Scholar
  120. 120.
    Steinhubl SR, Berger PB, Mann JT, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002; 288: 2411–20.PubMedCrossRefGoogle Scholar
  121. 121.
    Assali AR, Salloum J, Sdringola S, et al. Effects of clopidogrel pretreatment before percutaneous coronary intervention in patients treated with glycoprotein IIb/IIIa inhibitors (abciximab or tirofiban). Am J Cardiol 2001; 88: 884–6.PubMedCrossRefGoogle Scholar
  122. 122.
    Chan AW, Moliterno DJ, Berger PB, et al. Triple antiplatelet therapy during percutaneous coronary intervention is associated with improved outcomes including one-year survival results from the do Tirofiban And Reopro Give similar Efficacy outcome Trial (TARGET). J Am Coll Cardiol 2003; 42(7): 1187–95.CrossRefGoogle Scholar
  123. 123.
    Kastrati A, Mehilli J, Schuhlen H, et al. A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. N Engl J Med 2004; 350: 232–8.PubMedCrossRefGoogle Scholar
  124. 124.
    Dalby M, Montalescot G, Sollier CB, et al. Eptifibatide provides additional platelet inhibition in non-ST-elevation myocardial infarction patients already treated with aspirin and clopidogrel: results of the Platelet activity Extinction in non-Q-wave myocardial infarction with Aspirin, Clopidogrel, and Eptifibatide (PEACE) study. J Am Coll Cardiol 2004; 43(2): 162–8.PubMedCrossRefGoogle Scholar
  125. 125.
    Randomized trial of high loading dose of clopidogrel for reduction of periprocedural myocardial infarction in patients undergoing coronary intervention: results from the ARMYDA-2 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study. Circulation 2005; 111 (16): 2099–2106.Google Scholar
  126. 126.
    Bhatt DL, Topol EJ, et al. Clopidogrel added to aspirin versus aspirin alone in secondary prevention and high-risk primary prevention: rationale and design of the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. The CHARISMA Executive Committee. Am Heart J 2004; 148(2): 263–8.PubMedCrossRefGoogle Scholar
  127. 127.
    Sugidachi A, Asai F, Ogawa T, et al. The in vivo pharmacological profile of CS-747, a novel antiplatelet agent with platelet ADP receptor antagonist properties. Br J Pharmacol 2000; 129: 1439–46.PubMedCrossRefGoogle Scholar
  128. 128.
    Wiviott S. Joint utilization of medications to block platelets optimally (JUMBO)-TIMI 26: primary 30-day results with CS-747 (LY640315), a novel thienopyridine P2Y12 antagonist, compared to clopidogrel in PCI [oral presentation]. European Society of Cardiology Congress; 2004 Aug28–Sept 1; Munich.Google Scholar
  129. 129.
    Storey RF, Judge HM, Wilcox G, et al. Inhibition of ADP-induced P-selectin expression and platelet-leukocyte conjugate formation by clopidogrel and the P2Y12 receptor antagonist AR- C69931MX but not aspirin. Thromb Haemost 2002; 88: 488–94.PubMedGoogle Scholar
  130. 130.
    Storey F. The P2Y12 receptor as a therapeutic target in cardiovascular disease. Platelets 2001; 12: 197–209.PubMedCrossRefGoogle Scholar
  131. 131.
    Stadius ML. Diminishing returns... too many choices... the saga of pharmacologic therapy to reduce the complications of percutaneous coronary interventions. J Am Coll Cardiol 2004; 44: 25–7.PubMedCrossRefGoogle Scholar
  132. 132.
    Popma JJ, Berger P, Ohman EM, et al. The seventh ACCP Conference on antithrombotic and thrombolytic therapy: antithrombotic therapy during percutaneous intervention. Chest 2004; 126: 576S–5799S.PubMedCrossRefGoogle Scholar
  133. 133.
    Mohan NB, Lawrence J, Patrick B, et al. A hierarchical bayesian meta-analysis of randomized clinical trials of drug-eluting stents. Lancet 2004; 364: 583–91.CrossRefGoogle Scholar
  134. 134.
    Bavry AA, Kumnhani DJ, Quiroz R, et al. Invasive therapy along with glycoprotein IIb/IIIa inhibitors and intracoronary stents improves survival in non-ST-segment elevation acute coronary syndromes: a meta-analysis and review of the literature. Am J Cardiol 2004; 93: 830–5.PubMedCrossRefGoogle Scholar
  135. 135.
    Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364: 1519–1521.Google Scholar
  136. 136.
    Bhatt DL, Topol EJ. Scientific and therapeutic advances in antiplatelet therapy. Nature 2003; 2: 15–20.Google Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineCleveland Clinic FoundationClevelandUSA

Personalised recommendations