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The contemporary use of antiplatelet therapy in interventional cardiology 

The contemporary use of antiplatelet therapy in interventional cardiology
Chapter:
The contemporary use of antiplatelet therapy in interventional cardiology
Author(s):

Aung Myat

and Tony Gershlick

DOI:
10.1093/med/9780199569083.003.024
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date: 27 February 2020

Accepting that the adhesion, activation, and aggregation of platelets plays a central role in the initial formation and subsequent propagation of intracoronary thrombi, antiplatelet therapy (APT) has become central to the management of a number of manifestations of cardiovascular (CV) disease; not least in preventing the deleterious effects of stent thrombosis (ST) that can follow percutaneous coronary intervention (PCI) with stent deployment. PCI causes significant local trauma to the vessel wall leading to exposure of the subendothelium and release of its thrombogenic constituents into the intravascular environment resulting in an increased risk of vaso-occlusive complications. Exposure of the stent struts can further stimulate platelet adherence to the non-endothelialized vessel wall and accelerate activation and aggregation. Furthermore, PCI can also potentiate the release of vasoactive agents from the platelet-rich thrombus. This may be of particular importance when PCI is undertaken in those presenting with acute coronary syndromes (ACS) where plaque disruption has already locally activated platelets by exposing the flowing blood constituents to thrombogenic plaque contents.

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