ABC of interventional cardiology: Interventional pharmacotherapy

The dramatic increase in the use of percutaneous coronary intervention has been possible because of advances in adjunctive pharmacotherapy, which have greatly improved safety. Percutaneous intervention inevitably causes vessel trauma, with disruption of the endothelium and atheromatous plaque. This activates prothrombotic factors, leading to localised thrombosis; this may impair blood flow, precipitate vessel occlusion, or cause distal embolisation. Coronary stents exacerbate this problem as they are thrombogenic. For these reasons, drug inhibition of thrombus formation during percutaneous coronary intervention is mandatory, although this must be balanced against the risk of bleeding, both systemic and at the access site.​site. Figure 1 Action of antiplatelet and antithrombotic agents in inhibiting arterial thrombosis