Thrombotic events stents

Hardhammar, P.A., van Beusekom, H.M., Emanuelsson, H.U., Elofma, S.E1., Albertsson, P.A., Verdouw, P.D. et al. (1996) Reduction in thrombotic events with heparin-coated Palmaz-Schatz stents in normal porcine coronary arteries. Circulation, 93, 423 130. 

Limited data are available to link clopidogrel nonresponsiveness to the occurrence of thrombotic events. Matetzky et al. studied clopidogrel responsiveness in patients undergoing stenting for acute ST-elevation Ml. They found that patients who exhibited the highest quartile of ADP-induced aggregation had a 40% probability for a recurrent cardiovascular... 

Hardhammar P Van Beusekom H, Emanuelsson H, et al. Reduction in thrombotic events with heparin-coated Palmaz-Schatz stents in normal coronary arteries. Circulation 1996 93 423-430. 

Arterial thrombotic events are the leading cause of MI and have recently been identified as a major contributing factor to plaque progression. The detection of thrombus in a coronary artery is crucially important, as it is used to verily plaque rupture, evaluate the efficacy of thrombolytic therapy, assess the need for thrombectomy and determine the risk for distal embolization and thrombus protrusion through stent struts if percutaneous coronary intervention is warranted [69]. Unfortunately, no FDA-approved technology can accurately detect intraluminal thrombus. 

Clopidogrel is indicated for prevention of vascular ischaemic events in patients with symptomatic atherosclerosis. It is also used, along with aspirin, for the prevention of thromboembolism after placement of an intracoronary stent. Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so that a loading-dose is usually administered. Although rare, severe neutropenia and also thrombotic thrombocytopenic purpura may occur. 

Optimal stent implantation and new antiplatelet therapy have reduced the thrombotic complication after stent implantation, dramatically. However, thrombosis remains a challenge in some lesions and patient subgroups. As an initial and unavoidable event during stent implantation, thrombosis and platelet activation are also involved in the development of neointimal hyperplasia. Stents coated with heparin and other antithrombotic drugs have been demonstrated to decrease thrombotic complications, although their effect on neointimal hyperplasia remains uncertain. As heparin is attached to the stent surface, we divide thromboresistant stents as heparin-coated stents and drug-eluting thromboresistant stents. 

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