Peri-procedural and post-procedural antithrombotic pharmacotherapy

Summary

Peri- and post-procedural antithrombotic therapeutic strategies after coronary angiography (CAG) and percutaneous coronary intervention (PCI) with or without stent implantation is reviewed regularly by professional societies, respective updates of the ESC guidelines, but also by expert papers. This is particularly true for patients presenting with acute coronary syndromes (ACS) who are not only at risk for recurrent ischemic risk but frequently also are at bleeding risk. Prasugrel and ticagrelor, two stronger and faster acting antiplatelet agents (P2Y12- receptor inhibitors), have replaced clopidogrel in those patients and the use of the IV agent cangrelor has become of importance in P2Y12-inhibitor naive ACS patients due to its fast on- and off-effects. In contrast, GP IIb/IIIa-inhibitors (GPIs) have lost their previous importance in clinical routine and are mainly used downstream in bail-out situations.

The default recommendation of duration of dual antiplatelet therapy (DAPT) after coronary interventions in CCS (6 months) and ACS (12 months) patients is unchanged and based on the individual risk stratification including ischemic and bleeding risks. However, alternative antithrombotic strategies in form of individual patient-oriented therapeutic options, e.g. shortening of DAPT to 1-3 months, de-escalation or other modulation strategies have been developed.

Special knowledge has been gained in patients...