![]() Alternatively, a plaque healing phenomenon occurs when thrombus formation is contained repeated cycles of this process promote disease progression among patients with CCS (Figure 1) 14 17 18. ![]() In ACS patients, when plaque rupture or erosion occurs, the activation of coagulation cascade and platelets can lead to either subocclusive or occlusive thrombosis, causing a symptomatic event. ![]() The crosstalk between platelets, the haemostatic system and inflammatory pathways are key to atherosclerotic development and thrombotic complications occurring after plaque destabilisation 10 11 12 13 14 15 16. Platelets play a key role in thrombus formation and their initial tethering is mediated by the interaction between the complex glycoprotein (GP) Ib-IX-V and Von Willebrand factor and by collagen receptors present on the platelet surface such as GPVI (Figure 1) 7 8 9. Rationale for the use of antiplatelet therapy in patients undergoing percutaneous coronary interventionĪrterial thrombus formation is a complex and dynamic pathological process that is initiated within an injured blood vessel wall or by contact activation on a foreign surface 7. In this State-of-the-Art review, we provide the rationale, discuss the evidence and summarise the current and future directions of antiplatelet treatment regimens after PCI, with a specific focus on oral antiplatelet agents. These profiles, paralleled with an understanding of how individuals may have variable reactions to specific antiplatelet agents, have also laid the foundation for personalised treatment regimens with the goal of optimising efficacy and safety outcomes 6. Moreover, numerous investigations have also helped to develop a profile of patients at increased risk of ischaemic and bleeding complications 2. This is attributed to a number of factors including refinement in stent technologies, leading to safer (i.e., less thrombogenic) stent platforms, the development of new antiplatelet drugs, as well as an understanding of the prognostic implications associated with bleeding, the most feared trade-off associated with the use of antiplatelet therapies 2 5. Over the past four decades there has been an evolution in antiplatelet treatment regimens being used in patients undergoing PCI 2. Therefore, antithrombotic drugs, in particular antiplatelet agents, are key to the treatment and prevention of both local and systemic thrombotic complications 2 3. In fact, patients undergoing PCI may develop both acute and long-term ischaemic events 4. Adjunctive pharmacotherapy, in particular antithrombotic therapy, has a pivotal role in optimising outcomes in patients undergoing PCI 2 3. In patients with coronary artery disease (CAD), percutaneous coronary interventions (PCI) are the cornerstone of treatment for those presenting with an acute coronary syndrome (ACS) PCI has also been largely adopted in patients with chronic coronary syndromes (CCS) 1. In this State-of-the-Art review we provide the rationale, summarise the evidence, and discuss current and future directions of antiplatelet treatment regimens after PCI. Evidence from these investigations have resulted in a number of antithrombotic treatment options as recommended by recent guidelines. Numerous investigations have been conducted to better stratify patients undergoing PCI according to their ischaemic and bleeding risks and to implement antithrombotic regimens accordingly. The continuous refinement in stent technologies, together with the high incidence of ischaemic recurrences after PCI and the understanding of prognostic implications associated with bleeding, have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Antiplatelet therapy is key to reducing local thrombotic complications and systemic ischaemic events among patients undergoing percutaneous coronary interventions (PCI), but it is inevitably associated with increased bleeding.
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