ABSTRACT
It is essential for interventionists performing percutaneous coronary interventions (PCI) to have a thorough understanding of periprocedural anti-thrombotic therapies, which mitigate thrombotic as well as bleeding risks related to the procedure. Anti-platelet agents are amongst the most important adjunctive medications given in the setting of PCI, and a thorough understanding of platelet activation and interaction with vascular endothelium is needed to understand the mechanism of action of these agents. Aspirin is a cornerstone of effective anti-platelet therapy. The addition of a second oral anti-platelet agent to aspirin marked a significant advance in contemporary pharmacotherapy for PCI. Clopidogrel is an irreversible, 'second generation' P2Y12 receptor antagonist. As a pro-drug, it requires conversion into its active metabolite by the hepatic cytochrome P450 2C19 isoenzyme. Prasugrel is a 'third generation' thienopyridine that irreversibly inhibits the P2Y12 receptor. The adjunctive pharmacotherapy is used in coronary intervention a highly evidence-based discipline that is guided by decades of rigorous investigation.
