Anti-platelet and anti-thrombotic approaches in patients undergoing percutaneous coronary intervention

Over the past three decades, there has been a tremendous increase in the use of percutaneous coronary interventions (PCI) for the treatment of patients with atherosclerotic coronary artery disease. However, PCI causes disruption of atherosclerotic plaque and denudation of the endothelium, leading to stimulation of platelet aggregation and activation of the coagulation cascade. Therefore, anti-platelet and anti-thrombotic agents have a pivotal role as adjuncts before, during and after PCI, in order to minimize the risk of procedural ischemic complications, such as myocardial infarction, stent thrombosis, and various degrees of myonecrosis. The current article presents a comprehensive review of the evolution of current anti-platelet and anticoagulation regimens used in the setting of PCI. It starts with a summary of the current perspective of the coagulation process along with platelet activation and aggregation. The review then focuses specifically on individual anti-platelet and anti-thrombotic drugs including their mechanism of action and the scientific evidence which led to their use in PCI. Finally, we present summary recommendations from the AHA/ACC guidelines for individual anticoagulant and anti-platelet regimens given peri-PCI. © 2007 Wiley-Liss, Inc.