Antiplatelet therapy in patients undergoing coronary stent implantation: Italian Society of Interventional Cardiology consensus document

The Italian Society of Interventional Cardiology is aware of the existence of significant local and individual disparities and discordant prescriptions in antiplatelet therapy administered with coronary stents, a critical issue due to the large use of drug-eluting stents (DES), the increasing complexity of percutaneous coronary interventions and the more stringent requirement to avoid stent thrombosis. Current percutaneous coronary intervention is attempting more aggressively to treat difficult lesions and patient cohorts with a high procedural success rate. Double antiplatelet therapy with aspirin (ASA) and thienopyridine is the best current treatment to reduce the risk of coronary stent thrombosis. Due to the lower incidence of side-effects compared to ticlopidine, clopidogrel should be the thienopyridine of choice in association with ASA in the double antiplatelet regimen. However, the combination of delayed healing with DES and the increasing complexity of the stent implantation raises more demanding safety concerns about the dosage and duration of dual antiplatelet therapy.