Developing drugs for use before, during and soon after percutaneous coronary intervention.

Gargiulo, Giuseppe; Moschovitis, Aris; Windecker, Stephan; Valgimigli, Marco (2016). Developing drugs for use before, during and soon after percutaneous coronary intervention. Expert opinion on pharmacotherapy, 17(6), pp. 803-818. Informa Healthcare 10.1517/14656566.2016.1145666

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INTRODUCTION Percutaneous coronary intervention (PCI) is a milestone for treating coronary artery disease (CAD). Antithrombotic therapy is essential to prevent ischemic complications, including the microvascular no-reflow, while minimizing bleeding events. Areas covered: This overview discusses available and developing drugs for PCI including anticoagulants, antiplatelets and treatment of no-reflow. Expert opinion: For years unfractionated heparin (UFH) has been the unique anticoagulant to be used before and during PCI. Enoxaparin showed similar efficacy and safety, yet, based on recent trials, bivalirudin has been shown to have some benefits, particularly for patients with ST-segment elevation myocardial infarction (STEMI). The evidence concerning new anticoagulants is still preliminary, except for new oral anticoagulants, particularly rivaroxaban that showed intriguing findings and is currently under investigation. Dual antiplatelet therapy (DAPT) is the standard of care after PCI, but new developments have recently emerged. Indeed, ticagrelor and prasugrel are currently recommended over clopidogrel due to their significant reduction of ischemic events in acute coronary syndrome (ACS) whereas clopidogrel remains the choice in stable CAD. Among new agents, vorapaxar and cangrelor showed positive but limited evidence and might be considered at least in selected patients. Conversely, evidence on effective treatments for no-reflow remains limited and would require future dedicated research.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Gargiulo, Giuseppe; Moschovitis, Aris; Windecker, Stephan and Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1465-6566

Publisher:

Informa Healthcare

Language:

English

Submitter:

Daria Vogelsang

Date Deposited:

20 Apr 2016 10:45

Last Modified:

15 Sep 2017 16:34

Publisher DOI:

10.1517/14656566.2016.1145666

PubMed ID:

26800365

Uncontrolled Keywords:

anticoagulant, antiplatelet, drugs, no-reflow, percutaneous coronary intervention

URI:

https://boris.unibe.ch/id/eprint/78781

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