ABSTRACT
Introduction The past two decades have witnessed dramatic progress in interventional cardiology. The diversification of technology has enabled the treatment of lesions with greater complexity, while providing commensurate declines in adverse ischemic outcomes. However, coronary interventions are inherently thrombogenic, with each technique resulting in various degrees of controlled vascular injury, generating a milieu primed for coronary thrombus formation and cellular proliferation. Since many patients undergoing percutaneous coronary interventions (PCI) present with acute coronary syndromes, coupled with the continued evolution of catheter-based reperfusion for acute MI and the proliferation in stent usage, the pharmacological suppression of early and late thrombotic events remains a critical consideration. Fortunately, pharmacological developments have paralleled the growth in interventional device technology. While pharmacological solutions to the problem of restenosis remain elusive (discussed elsewhere), the array of anti-thrombin and anti-platelet therapies available to the clinical interventional cardiologist continues to broaden. Furthermore, attempts to improve the outcomes from PCI have moved beyond the target lesion and towards the coronary microvasculature. The currently available anti-thrombin and anti-platelet therapies will be presented in this chapter, focusing on the evidence supporting their use in the catheterization laboratory and the controversies that surround their clinical application.
