Antithrombotic Therapy in Patients with Cardiovascular Disease

Abstract

Antiplatelet therapy after coronary stent implantation is essential to prevent stent thrombosis. Drug-eluting stents (DES), which are reported to prevent restenosis, have become the preferred stents in patients undergoing percutaneous coronary intervention. Current guidelines recommend that dual antiplatelet therapy with aspirin and a thienopyridine should be administered for at least 12 months after implantation of a DES, followed by single antiplatelet therapy with aspirin for life. If antiplatelet therapy must be interrupted for any surgical procedure, aspirin and/or thienopyridine should be withdrawn 7 to 14 days before the procedure. Anticoagulant drugs are used mainly for patients with atrial fibrillation to prevent ischemic stroke. Although in the past, warfarin was the only available oral anticoagulant, novel oral anticoagulants (NOAC) are increasingly becoming available as alternate agents. The short half-life of the NOAC coupled with their rapid onset/offset of action should allow for a shorter period of drug cessation prior to surgical procedures. Since patients receiving antithrombotic drugs have diverse backgrounds, good cooperation must be ensured among specialists involved in the treatment of a case for assessing the risk of hemorrhage (or thrombosis) should antithrombotic therapy be continued (or withdrawn).