Circulation. 2007;115:813-818
Published online before print January 15, 2007, doi: 10.1161/CIRCULATIONAHA.106.180944
Published online before print January 15, 2007, doi: 10.1161/CIRCULATIONAHA.106.180944
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(Circulation. 2007;115:813-818.)
© 2007 American Heart Association, Inc.
AHA/ACC/SCAI/ACS/ADA Science Advisory |
Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents
A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, With Representation From the American College of Physicians*
Dual antiplatelet therapy with aspirin and a thienopyridine has been shown to reduce cardiac events after coronary stenting. However, many patients and healthcare providers prematurely discontinue dual antiplatelet therapy, which greatly increases the risk of stent thrombosis, myocardial infarction, and death. This advisory stresses the importance of 12 months of dual antiplatelet therapy after placement of a drug-eluting stent and educating the patient and healthcare providers about hazards of premature discontinuation. It also recommends postponing elective surgery for 1 year, and if surgery cannot be deferred, considering the continuation of aspirin during the perioperative period in high-risk patients with drug-eluting stents.
Key Words: AHA Scientific Statements • thrombosis • myocardial infarction • stents • myocardial stunning
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
M. C. Nguyen, Y. L. Lim, A. Walton, J. Lefkovits, G. Agnelli, S. G. Goodman, A. Budaj, D. C. Gulba, J. Allegrone, D. Brieger, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the Global Registry of Acute Coronary Events: is it safe and effective to use just one antiplatelet agent? Eur. Heart J., July 2, 2007; 28(14): 1717 - 1722. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Spinler and R. L. Wilensky Duration of clopidogrel therapy after placement of drug-eluting intracoronary stent Am. J. Health Syst. Pharm., July 1, 2007; 64(13): 1432 - 1434. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 A. V. Finn, G. Nakazawa, M. Joner, F. D. Kolodgie, E. K. Mont, H. K. Gold, and R. Virmani Vascular Responses to Drug Eluting Stents: Importance of Delayed Healing Arterioscler. Thromb. Vasc. Biol., July 1, 2007; 27(7): 1500 - 1510. [Abstract] [Full Text] [PDF]
|
|