November 2, 1995European Heart Journal
Prevention and management of thrombotic complications during coronary interventions: Combination therapy with antithrombins, antiplatelets, and/or thrombolytics: risks and benefits
Key result
Medical therapy with antiplatelets and antithrombins reduces the incidence of procedure-related coronary occlusion, which occurs in about 5% of percutaneous transluminal coronary interventions.
Why the study?
Does combination therapy with antithrombins, antiplatelets, and/or thrombolytics prevent thrombotic complications in patients undergoing coronary interventions?
Population
Patients undergoing percutaneous transluminal coronary intervention
Design
Review
Authors
Discussion
Loading...
Member takes
Implication
Affirms antiplatelet-antithrombin regimens in coronary interventions; leaves optimal combinations and thrombolytic role open for prospective study.
Key Points
- To review the efficacy, dosing strategies, and safety profiles of antiplatelet agents, antithrombins, and thrombolytics in preventing and managing acute thrombotic complications during coronary interventions.
- Evaluation of clinical evidence on pre-procedural and post-procedural antiplatelet regimens, focusing on aspirin and ticlopidine.
- Review of intravenous heparin anticoagulation protocols and target activated partial thromboplastin time (aPTT) thresholds during angioplasty.
- Assessment of adjunctive and rescue thrombolytic therapy outcomes and associated bleeding risks during percutaneous transluminal coronary interventions.
- Acute coronary occlusions occur in approximately 5% of percutaneous interventions, with pre-treatment (250–500 mg) and post-treatment (100–300 mg) aspirin significantly lowering procedure-related occlusion rates.
- Thrombin inhibition with heparin (recommended 10,000 U bolus followed by 1,000 U/h infusion or adjusted to maintain aPTT greater than three times control) serves as an essential therapy against acute thrombosis.
- Adjunctive thrombolysis fails to reduce periprocedural occlusion rates, provides no clinical superiority over prolonged balloon inflation or stenting in acute occlusion, and carries substantial bleeding risks.
Structured PICO
Does combination therapy with antithrombins, antiplatelets, and/or thrombolytics prevent thrombotic complications in patients undergoing coronary interventions?
P
Population
Patients undergoing percutaneous transluminal coronary intervention
I
Intervention
Combination therapy with antithrombins (heparin), antiplatelets (aspirin, ticlopidine), and/or thrombolytics
O
Outcome
Prevention and management of acute occlusions and thrombotic complications
Aspirin and heparin are the mainstays of preventing thrombotic complications during coronary interventions, whereas thrombolysis has limited utility and high bleeding risk.
Cite This Study
Neuhaus et al. (1995) conducted a review in Thrombotic complications during coronary interventions. Combination therapy with antithrombins, antiplatelets, and/or thrombolytics was evaluated. Medical therapy with antiplatelets and antithrombins reduces the incidence of procedure-related coronary occlusion, which occurs in about 5% of percutaneous transluminal coronary interventions.