Dual antiplatelet therapy in the drug-eluting stent era

Abstract

Data continue to accumulate showing that implantation of coronary stents, particularly drug-eluting stents (DES), is associated with persistent, long-term risk of thrombotic events. Dual antiplatelet therapy with aspirin and clopidogrel has reduced the risk of early and late thrombosis. However, early risk persists due to implantation, stent-related factors, and suboptimal response to clopidogrel, whereas late risk persists due not only to these factors, but to the limited duration of dual antiplatelet therapy as well. Third-generation oral P2Y12 antagonists that exhibit faster onset of action and greater and more consistent inhibition of platelet aggregation than clopidogrel include the new thienopyridine prasugrel and the reversible P2Y 12 inhibitor AZD6140. Prospective, randomized, long-term trials are warranted to investigate the benefits and risks of more effective P2Y 12 antagonists as part of dual antiplatelet therapy after both bare-metal stent and DES implantation. © The Author 2008.