Antiplatelet therapy for elective coronary stenting: a moving target.

The recognition of the major contribution of platelet-mediated mechanisms to the pathogenesis of thrombotic complications after coronary stenting has led to the development and evaluation of different antiplatelet regimens. The combination of aspirin and adenosine diphosphate antagonists such as ticlopidine and clopidogrel has solved the issue of acute stent thrombosis. The timing and dose of dual oral antiplatelet therapy have, however, changed over time with a shift from postintervention treatment to preintervention treatment with a high loading dose of clopidogrel. Pretreatment with aspirin and clopidogrel has been associated with a further 30% reduction in ischemic complications after coronary intervention. Recent data have even shown that in case of optimal pretreatment with such a dual oral antiplatelet therapy, glycoprotein IIb/IIIa antagonists are no longer mandatory for elective coronary stenting and should be reserved only for high-risk procedures or for acute coronary interventions.