- Email: [email protected]
Antiplatelet and Anticoagulation Therapy in Percutaneous Coronary Intervention
Antiplatelet and Anticoagulation Therapy in PCI
PREFACE Antiplatelet and Anticoagulation Therapy in Percutaneous Coronary Intervention
Dominick J. Angiolillo, MD, PhD
Matthew J. Price, MD
Editors
Ever-evolving devices and transcatheter techniques define the field of interventional cardiology and its core procedure, percutaneous coronary intervention (PCI). Yet, the success of PCI has been intertwined with advancements in and the optimal use of medical therapies, as adjunctive pharmacology critically influences post-PCI acute and long-term outcomes. The introduction of newer, more effective, and/or safer antiplatelet and anticoagulant agents over the past decade is a boon for patients but has also increased the complexity of the interventionalist’s decision making. There is almost a dizzying array of antiplatelet agents that are now commercially available, studied in different populations and carrying different indications, contraindications, side effects, and drug-drug interactions. The clinician must also integrate new data that address the optimal timing to administer these agents and their treatment duration. The global burden of atrial fibrillation is increasing as the population ages, and a growing proportion of patients undergoing PCI are treated with vitamin K–dependent or non–vitamin K–dependent oral anticoagulants, further complicating shortand long-term treatment decisions. This issue of Interventional Cardiology Clinics serves to put forth the current “state-of-the-art” for antiplatelet and anticoagulant therapy in patients undergoing PCI, written by leaders in the field. Dr Stalker and colleagues present the more nuanced picture of thrombosis that has recently emerged, incorporating the coordination of
Intervent Cardiol Clin 6 (2017) xi–xii http://dx.doi.org/10.1016/j.iccl.2016.10.001 2211-7458/17/ª 2016 Published by Elsevier Inc.
multiple signaling pathways across time and space, which may influence the efficacy and safety of different antithrombotic agents. Drs Angiolillo and Capodanno summarize the clinical data that address the role of pretreatment with oral P2Y12 antagonists prior to angiography and in turn question the traditional status quo. Drs Price, Storey, and Tricoci discuss novel antiplatelet agents that are administered intravenously, have off-target effects, and provide inhibition through targets other than the platelet P2Y12 receptor. Drs Rollini and Angiolillo lay forth a framework based on clinical and pharmacodynamic studies that can be followed when the clinician feels it is necessary to switch P2Y12 antagonists. Dr Lip and Dr Verheught address the conundrum of “triple therapy” with anticoagulants and dual antiplatelet therapy after PCI and for the treatment of ACS, respectively. A large body of randomized clinical trial data that addresses the rationale for antiplatelet therapy beyond stent-related outcomes has recently been published, and Dr Bonaca synthesizes these results and how they should influence the practice of interventional cardiologists. Finally, Drs Cavallari and Sibbing provide an update of the role of precision medicine in the management of antiplatelet therapy in patients with coronary artery disease. The goal of Interventional Cardiology Clinics is to provide the practicing and academic interventional cardiologist a resource that is more in-depth than a review journal but more fluid and
xii
Preface
cutting edge than a textbook. We believe that this issue meets—indeed, exceeds—that goal. Dominick J. Angiolillo, MD, PhD University of Florida College of Medicine-Jacksonville Division of Cardiology-ACC Building 5th Floor 655 West 8th Street Jacksonville, FL 32209, USA
Matthew J. Price, MD Scripps Clinic 9898 Genesee Avenue Suite AMP-200 La Jolla, CA 92037, USA E-mail addresses: [email protected] (D.J. Angiolillo) [email protected] (M.J. Price)
PREFACE Antiplatelet and Anticoagulation Therapy in Percutaneous Coronary Intervention
Dominick J. Angiolillo, MD, PhD
Matthew J. Price, MD
Editors
Ever-evolving devices and transcatheter techniques define the field of interventional cardiology and its core procedure, percutaneous coronary intervention (PCI). Yet, the success of PCI has been intertwined with advancements in and the optimal use of medical therapies, as adjunctive pharmacology critically influences post-PCI acute and long-term outcomes. The introduction of newer, more effective, and/or safer antiplatelet and anticoagulant agents over the past decade is a boon for patients but has also increased the complexity of the interventionalist’s decision making. There is almost a dizzying array of antiplatelet agents that are now commercially available, studied in different populations and carrying different indications, contraindications, side effects, and drug-drug interactions. The clinician must also integrate new data that address the optimal timing to administer these agents and their treatment duration. The global burden of atrial fibrillation is increasing as the population ages, and a growing proportion of patients undergoing PCI are treated with vitamin K–dependent or non–vitamin K–dependent oral anticoagulants, further complicating shortand long-term treatment decisions. This issue of Interventional Cardiology Clinics serves to put forth the current “state-of-the-art” for antiplatelet and anticoagulant therapy in patients undergoing PCI, written by leaders in the field. Dr Stalker and colleagues present the more nuanced picture of thrombosis that has recently emerged, incorporating the coordination of
Intervent Cardiol Clin 6 (2017) xi–xii http://dx.doi.org/10.1016/j.iccl.2016.10.001 2211-7458/17/ª 2016 Published by Elsevier Inc.
multiple signaling pathways across time and space, which may influence the efficacy and safety of different antithrombotic agents. Drs Angiolillo and Capodanno summarize the clinical data that address the role of pretreatment with oral P2Y12 antagonists prior to angiography and in turn question the traditional status quo. Drs Price, Storey, and Tricoci discuss novel antiplatelet agents that are administered intravenously, have off-target effects, and provide inhibition through targets other than the platelet P2Y12 receptor. Drs Rollini and Angiolillo lay forth a framework based on clinical and pharmacodynamic studies that can be followed when the clinician feels it is necessary to switch P2Y12 antagonists. Dr Lip and Dr Verheught address the conundrum of “triple therapy” with anticoagulants and dual antiplatelet therapy after PCI and for the treatment of ACS, respectively. A large body of randomized clinical trial data that addresses the rationale for antiplatelet therapy beyond stent-related outcomes has recently been published, and Dr Bonaca synthesizes these results and how they should influence the practice of interventional cardiologists. Finally, Drs Cavallari and Sibbing provide an update of the role of precision medicine in the management of antiplatelet therapy in patients with coronary artery disease. The goal of Interventional Cardiology Clinics is to provide the practicing and academic interventional cardiologist a resource that is more in-depth than a review journal but more fluid and
xii
Preface
cutting edge than a textbook. We believe that this issue meets—indeed, exceeds—that goal. Dominick J. Angiolillo, MD, PhD University of Florida College of Medicine-Jacksonville Division of Cardiology-ACC Building 5th Floor 655 West 8th Street Jacksonville, FL 32209, USA
Matthew J. Price, MD Scripps Clinic 9898 Genesee Avenue Suite AMP-200 La Jolla, CA 92037, USA E-mail addresses: [email protected] (D.J. Angiolillo) [email protected] (M.J. Price)