ABSTRACT
Coronary stenting, initially introduced for the management of abrupt vessel closure and dissection, has evolved over the past decades to become applicable to a range of patients, indications, and lesions. However the initial series was met with an alarmingly high rate (~20%) of acute stent thrombosis. This was promptly reduced with a combination of anticoagulation and antiplatelet therapies. The result of this combination was associated with markedly higher rates of bleeding. Subsequently, the introduction of thienopyridines and dual antiplatelet therapy became the standard of care after percutaneous coronary intervention (PCI) with bare-metal stenting for a minimum of four weeks and was associated with a significantly lower risk of bleeding complications. With the increased utilization of PCI with stenting over the past few years, more patients are presenting with an indication for anticoagulation following PCI. Furthermore, the American College of Cardiology (ACC), the American Heart Association (AHA), and the Society for Cardiovascular Angiography and Interventions (SCAI) currently recommend a prolonged course of dual antiplatelet therapy up to one year following drug-eluting stent to prevent late stent thrombosis. (1).Because of the requirement for this prolonged antiplatelet therapy, patients with atrial fibrillation, mechanical heart valve, stroke, and venous thromboembolic disease requiring oral anticoagulation therapy represent an extremely challenging group in whom optimal antithrombotic therapy remains poorly defined.
