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| Dr Pierre Aubry is a Consultant
Cardiologist at the Bichat-Claude
Bernard Hospital in Paris. He trained
at Paris VII University and became a
certified Cardiologist in 1983. He
has a particular interest in
interventional cardiology. He has
been involved in clinical studies
focusing on antithrombotic therapy,
contrast media, stent devices, and
management of acute coronary
syndromes. His current research
interests include prevention of
contrast-induced nephrotoxicity,
evaluation of efficiency of
antiplatelet agents and thrombin
inhibitors, and percutaneous closure
of atrial septal defects. Dr Aubry has
published in peer-reviewed journals
including the New England Journal
of Medicine, Circulation, and the
Journal of the American College of
Cardiology, and he is a reviewer for
Catheterization and
Cardiovascular Interventions. |
Review of antithrombotic therapy for percutaneous coronary interventions
Pierre Aubry,MD, Mohamed
Majdoub,MD, Antoine Sauguet, MD
Department of Cardiology
Groupe Hospitalier Bichat-Claude Bernard, Assistance
Publique-Hôpitaux de Paris, Paris, France.
Address for correspondence:
Dr Pierre Aubry
Département de Cardiologie,
Groupe Hospitalier Bichat-Claude Bernard,
46 rue Henri Huchard, 75018 Paris, France.
Tel : +33-1-40-25-86-65
Fax : +33-1-40-25-88-65
Email: pcaubry@yahoo.fr
Abstract
Antithrombotic therapy is a cornerstone in the
management of acute coronary syndromes and plays a
major role during percutaneous coronary interventions.
Numerous antithrombotic agents are currently
available, showing synergistic effects in combination. In
considering the physiological basis of thrombosis,
platelets and coagulation are seen as interdependent
and cannot be dissociated in therapeutic strategies.
Nevertheless, new antithrombotic agents and new
protocols are emerging.
The use of potent antithrombotic agents may be
associated with increased bleeding complications and
additional costs.With this in mind, recommendations
and expert consensus documents aim to help
interventionists in clinical practice. Currently, dual
antiplatelet therapy with aspirin and clopidogrel is the
standard treatment after stenting, although
development of direct thrombin inhibitors may soon
change anticoagulation practices. Indications for
intravenous GP IIb-IIIa antagonists need to be redefined
according to current management of acute coronary
syndromes and reliable tests are needed for the
monitoring of antiplatelet activity. Insufficient platelet
inhibition with standard therapy should be discussed
when subacute stent thrombosis occurs. In addition to
technological advances with newer devices, further
studies must continue to assess antithrombotic
strategies in terms of protective effects and bleeding risks.
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