chapter  25
8 Pages

Bleeding complications: anticoagulant and antiplatelet therapy control

WithKen Kozuma, Takaaki Isshiki

Introduction Treatment of coronary artery disease is usually initiated with antithrombotic agents, since fatal coronary events are always associated with atherothrombosis. In addition, with the rapid progress in interventional cardiology, the importance of antiplatelet and anticoagulant agents is increasing. Percutaneous coronary intervention (PCI) necessarily damages the arterial wall and dislodges atherosclerotic plaques. Therefore, the use of antithrombotic drugs is essential to prevent thrombus formation. Heparin has been used as a basic agent. It has been demonstrated that underdosing of heparin lead to thrombotic complications during PCI. 1 Other anticoagulant therapy is mainly required when severe flow disturbance or turbulence exists in the heart, and is not necessary for atherosclerotic plaque. Specifically, valvular heart disease (including prosthetic valves), aortic graft disease, and atrial fibrillation are the common indications for anticoagulant therapy besides heparin, whereas antiplatelet therapy is more effective in reducing the complications of coronary artery disease.