Abstract
The introduction of drug-eluting stents (DES) has resulted in improvement rates of restenosis and the need for repeat revascularization. However, with widespread use of DES, which reaches more than 80% of used coronary stents, concern has been raised regarding the long-term safety of this technology. The development of newer anti-restenotic agents, polymeric coatings as well as stent platforms resulted in newer DES which are associated with better safety and efficacy results. Additionally, the drawback of the first and second-generation thienopyridines, namely the rate of non-responder and interaction with other agents resulting in a lack of pharmacodynamic effect, was overcome with the development of newer generation thienopyridines. The effect of these newer agents was proven in several randomized controlled trials in different clinical settings resulting in an update of national and international guidelines. To date there is a controversies regarding antiplatelet therapy in patients being on oral anticoagulation. It is estimated that 5-7% of patients undergoing percutaneous coronary intervention have an indication for oral anticoagulation. There is a need for oral anticoagulation to prevent ischemic cerebrovascular events, and a need for dual antiplatelet therapy to prevent stent thrombosis. The combination of these, the triple therapy, results in an increase of bleeding complications, which are highly predictive of increased mortality in patients undergoing coronary intervention. With newer data from one randomized controlled trial, several ongoing randomized trials and data from several non-randomized trials the unprecisely recommendations of guidelines may change within the next update. However, there is a lack of data regarding antithrombotic strategy with respect to newer oral anticoagulants and newer generation thienopyridines. This special issue gives an overview of latest data regarding developments in drug-eluting stents and thienopyridines. Additionally it focuses on the widely debated topic of stent thrombosis and treatment strategy in oral anticoagulated patients. Thus, the readers will have an update on the complex and enlarging field of drug-eluting stents.
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