Ticlopidine and aspirin therapy following implantation of coronary artery stents

A number of studies evaluated the pharmacologic management of patients with coronary artery stents. Four studies demonstrated a low subacute thrombosis rate with antiplatelet therapy without implementation of anticoagulant therapy. However, in three of these trials conflicting results were reported regarding the relative efficacy of various antiplatelet therapies. Given the limitations of these studies, well-designed, randomized studies are necessary to assess the relative superiority of antiplatelet regimens to determine the safest and most effective treatment. Two clinical studies evaluated antiplatelet therapy compared with anticoagulant therapy in patients receiving coronary artery stents. Compared with conventional anticoagulant therapy, combined antiplatelet therapy with ticlopidine and aspirin appears to reduce clinical cardiovascular events, stent thrombosis, and hemorrhagic complications. Despite the potential benefits of therapy with ticlopidine observed in these studies, hematologic monitoring is required to detect neutropenia that may occur during ticlopidine therapy. In addition, the potential benefits of combination therapy with ticlopidine and aspirin apply only to patients at low risk as defined by the ACCP and ACC expert panels. Until further data become available, high-risk patients should be managed with conventional anticoagulation regimens. Studies are needed to determine whether antiplatelet therapy is effective in high-risk patients and the optimal antiplatelet therapy (ticlopidine, aspirin, or ticlopidine/aspirin) for the management of patients with coronary artery stents.

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