Monitoring and Reversal of Anticoagulation and Antiplatelets

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Key points

  • Combination therapy with anticoagulants and antiplatelets during percutaneous coronary intervention reduces incidence of stent thrombosis.

  • The role of monitoring during percutaneous coronary intervention is variable depending on the type of antithrombotic used.

  • Clinical benefit of tailored antiplatelet therapy based on point-of-care tests has yet to be proved.

  • Reversal agents (if available) for the various antithrombotics may be necessary when major bleeding occurs or emergent surgery is needed.

Anticoagulants

Predisposition to thrombosis during catheterization exists because of exposure of clotting factors to disrupted endothelium, catheters, and guidewires. The goals of anticoagulation therapy are to minimize thrombus propagation on the endovascular surface and formation of new thrombi from PCI equipment use.5, 12 Ideal anticoagulation would effectively prevent thrombus formation, have low risk of bleeding, have safe monitoring profile, have short duration of effect (half-life), and could be

Antiplatelets

Platelets are a key player in thrombotic events. Once the integrity of normal endothelium has been compromised, platelet adhesion, activation, and aggregation lead to formation of thrombus. Adhesion of platelets to the site of vessel wall injury occurs via von Willebrand factor and other GP cell receptors (GP Ib/IX/V, GP IV, GP VI, GP Ia/IIa). Once platelets start adhering, they become activated, initiating further activation of surrounding platelets through the secretion of platelet granules

Summary

Anticoagulation and antiplatelet therapy have been heavily studied since their inception. Although certain agents have advantages and disadvantages relative to others, there will likely never be a 1 size fits all medication. The art of practicing medicine requires tailoring therapy based on the unique patient being treated. This statement holds true during PCI as well, in which certain presentations or preexisting comorbidities make 1 anticoagulant or antiplatelet agent better than another. It

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  • Disclosure: The authors have nothing to disclose.

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