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(Circulation. 2005;111:1097-1099.)
© 2005 American Heart Association, Inc.

Editorial

Dual Antiplatelet Therapy for Coronary Stenting

A Clear Path for a Research Agenda

Jane A. Leopold, MD; Elliott M. Antman, MD

From the Whitaker Cardiovascular Institute, Boston University School of Medicine and Cardiovascular Division, Boston Medical Center (J.A.L.), and the Cardiovascular Division, Brigham and Women’s Hospital (E.M.A.), Boston, Mass.

Correspondence to Elliott M. Antman, MD, Senior Associate Editor, Director, Samuel A. Levine Cardiac Unit, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail eantman@rics.bwh.harvard.edu

Key Words: Editorials • stents • anticoagulants • platelet aggregation inhibitors • aspirin

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

	Introduction

 
It was an important and indeed remarkable observation when several trials reported the consistent finding that dual antiplatelet therapy with aspirin and a thienopyridine was superior to aspirin and oral anticoagulation for prevention of major adverse cardiac events after deployment of a stent in a coronary artery.¹ A major benefit of dual antiplatelet therapy was a lower rate of stent thrombosis. The incidence of coronary stent thrombosis in the modern era is reported to be approximately 1%, with an increased likelihood of occurrence in high-risk patient or lesion subsets. Although this rate may seem relatively low, stent thrombosis is associated with major myocardial infarction (MI) in 60% to 70% of cases, resulting in an early mortality rate of 20% to 25%. With increased use of percutaneous coronary intervention (PCI) as a revascularization strategy and implantation of stents in coronary arteries with a small diameter, it is anticipated that the number of patients at risk for stent thrombosis may increase. It therefore continues to be important to construct pharmacological regimens that minimize its occurrence. Several risk factors for stent thrombosis have been identified, including patient- and/or lesion-specific characteristics, procedure-related factors, and inherent stent thrombogenicity.² These risk factors, in turn, contribute to a state of enhanced platelet reactivity and thrombus formation, which promotes abrupt vessel closure.

See p 1153

Although initial studies highlighting the benefits of dual antiplatelet therapy used aspirin and ticlopidine, clopidogrel is the thienopyridine of choice today because it is associated with a lower rate of intolerable side effects. . . . [Full Text of this Article]

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