Antithrombotic Therapy for Percutaneous Cardiovascular Interventions: From Coronary Artery Disease to Structural Heart Interventions.

Alessandro Caracciolo,Francesco Costa,Victoria Garcia-Ruiz,Alberto Polimeni,Francesco Saporito,Guillaume Marquis-Gravel,Gennaro Giustino,Salvatore Galasso,Paolo Mazzone,Scipione Carerj,Fabrizio D’Ascenzo,Giulia Laterra

doi:10.3390/jcm8112016

Abstract

Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy.

Highlights

IntroductionWhile the techniques and the devices were improved in the following years, the introduction of the coronary stent and its first-in-man implantation in 1986 by Jacques Puel, dramatically improved early and late results of percutaneous coronary intervention (PCI), yet introducing a novel clinical issue: stent thrombosis
The link between percutaneous cardiovascular intervention and antithrombotic therapy begins right at the time of the first coronary angioplasties performed by Andreas Grüntzig
Similar antithrombotic practices were implemented for other percutaneous cardiovascular interventions such as atrial septal defect [8,9] or patent foramen ovale (PFO) closure [5,10], and more recently transcatheter aortic valve implantation (TAVI) [11] and transcatheter mitral valve repair (TMVR), in which the evidence coming from the coronary intervention field has been extrapolated to structural heart interventions

Summary

Introduction

While the techniques and the devices were improved in the following years, the introduction of the coronary stent and its first-in-man implantation in 1986 by Jacques Puel, dramatically improved early and late results of percutaneous coronary intervention (PCI), yet introducing a novel clinical issue: stent thrombosis. This complication occurred in up to 10% of cases at that time, and while a treatment with warfarin alone or warfarin plus aspirin was common after PCI and stent implantation, the rate of stent thrombosis remained high. We touch upon the current evidence, recommendations and future perspectives for antithrombotic therapy in patients undergoing structural heart interventions

Objectives

Methods

Conclusion