Antiplatelet agents stents

The AHA/ASA guidelines recommend that antiplatelet therapy as the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in noncardioembolic strokes. Aspirin, dopidogrel, and extended-release dipyridamole plus aspirin are all considered first-line antiplatelet agents (see Table 13-1). The combination of aspirin and clopido-grel can only be recommended in patients with ischemic stroke and a recent history of myocardial infarction or coronary stent placement and then only with ultra-low-dose aspirin to minimize bleeding risk. 

Sekiguchi M, Hoshizaki H, Adachi H, Ohshima S, Taniguchi K, Kurabayashi M, Effects of antiplatelet agents on subacute thrombosis and restenosis after successful coronary stenting A randomized comparison of ticlopidine and cilostazol. Circ J 2004 68(7) 6I0-6I4,... 

The development of novel and powerful antiplatelet agents has improved outcomes after PCI. In the CADILLAC trial, the use of a glycoprotein Ilb-IIIa inhibitor improved outcome in those treated with either balloon angioplasty or an intracoronary stent (21). Similarly, treatment with clopidogrel, a thienopyridine, decreases the incidence of adverse events after PCI (22,23). Neither thienopyridines nor glycoprotein Ilb-IIIa antagonists were available at the time the early trials designed to test the potential clinical efficacy of a combined approach were performed. 

Cardiovascular The utility of pretreatment with antiplatelet agents and stent-assisted coil embolization of ruptured wide-neck aneurysms in the setting of acute subarachnoid haemorrhage was evaluated in 65 patients. Patients were treated intraoperatively with 600 mg of clopidogrel immediately after stent placement and maintained with 75 mg of clopidogrel and 81 mg of aspirin daily. Infrequent major bleeding complications secondary to antiplatelet therapy were identified [40 ]. 

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