ANTITHROMBOTIC THERAPY AFTER INTRACORONARY STENTING

Conventional percutaneous transluminal coronary angioplasty may result in complications such as abrupt closure and late restenosis. This has led to increased application of mechanical revascularization techniqu es including intracoronary stents. In the past, subacute thrombosis af ter intracoronary stenting mandated anticoagulation with warfarin for a minimum of 1 month, with aspirin (ASA) started before the procedure and continued indefinitely. New information suggests that high-pressur e balloon inflation, with or without intracoronary ultrasound guidance to ensure successful stent placement, may permit reduction in the ant ithrombotic regimen to ASA, continued indefinitely, and ticlopidine, c ontinued for 1-3 months. However, the majority of trials supporting th is practice are primarily small, nonrandomized, observational studies. One randomized study found a lower frequency of cardiac events, inclu ding thrombosis, as well as fewer bleeding complications with combined antiplatelet therapy with ticlopidine compared with anticoagulant the rapy with phenprocoumon. Intracoronary stenting without anticoagulatio n would permit shorter hospitalization and lead to cost-savings. This has led many cardiologists to administer ASA and ticlopidine without b enefit of data from randomized, blinded clinical trials. Antithromboti c therapy after coronary artery stenting is in an evolutionary stage, and additional information regarding the safety and efficacy of ASA an d ticlopidine is necessary.