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Controversies in Interventional Cardiology

Should dual antiplatelet therapy after drug-eluting stents be continued for more than 1 year?

Dual Antiplatelet Therapy After Drug-Eluting Stents Should Be Continued for More Than One Year and Preferably Indefinitely

Adnan K. Chhatriwalla, MD and Deepak L. Bhatt, MD, MPH, FAHA

From the Division of Cardiovascular Medicine (A.K.C.), Cleveland Clinic, Cleveland, Ohio; and the Division of Cardiology (D.L.B.), VA Boston Health Care System and Brigham and Women’s Hospital, Boston, Mass.

Correspondence to Deepak L. Bhatt, MD, MPH, FAHA, 75 Francis Street, Boston, MA 02115. E-mail dlbhattmd@alum.mit.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Since its introduction, percutaneous coronary intervention (PCI) has been limited by 2 major factors: restenosis and vessel closure attributable to thrombosis. The use of coronary stents has had a marked beneficial impact on rates of restenosis.^1,2 However, the vessel trauma that occurs during PCI induces platelet activation, and all currently available coronary stents are made of metal and are therefore thrombogenic. The use of drug-eluting stents (DES) can reduce restenosis and target vessel revascularization by >70% compared with bare metal stents (BMS).^3,4 However, the polymer coatings and other aspects of DES may result in increased thrombogenicity compared with BMS.⁵

Response by Colombo and Gerber p 217

Early PCI studies reported rates of acute and subacute vessel closure approaching 25%.^6,7 As a result, many antithrombotic and antiplatelet regimens have been investigated to maximize benefit and to reduce complications in patients undergoing PCI. The addition of dipyridamole to aspirin showed no benefit in reducing acute PCI complications compared with aspirin alone.⁸ Similarly, very high–dose aspirin (1500 mg/d) did not reduce rates of myocardial infarction (MI) or need for surgical revascularization compared with low-dose aspirin therapy (80 mg/d).⁹ The addition of warfarin to aspirin therapy has been shown to slightly reduce the risk of cardiovascular events; however, this is accompanied by a significant increase in the risk of hemorrhagic complications.¹ Dual antiplatelet therapy with aspirin in combination with thienopyridine agents, which have complementary mechanisms of action (Figure 1),¹⁰ has resulted in the greatest improvements in PCI outcomes. In the Stent Anticoagulation . . . [Full Text of this Article]