The Development of Antiplatelet Therapy after Percutaneous Coronary Intervention

Coronary artery disease (CAD) is a common disease and has an impact in all over the word. With the development of life level and life style, the incident of morbidity and mortality largely increased [1]. Atherogenesis and the formation of thrombi are the main risk events. The application of percutaneous coronary intervention (PCI) released coronary artery disease and improved patients’ quality of life. The mortality of acute coronary syndrome (ACS) was obviously reduced [2]. The stent style including baremetal stents (BMS) and drug-eluting stents (DES) benefited many patients in clinic [3]. Antiplatelet therapy is standard treatment after PCI. Meanwhile, international guidelines and clinical practice recommend dual antiplatelet therapy (DAPT aspirin combination with P2Y12 inhibitors) after PCI [4,5]. Previous clinical application indicated that DES reduced major advent cardiac such as death, non-fatal myocardial infarction target lesion revascularization [6]. But the risk of stent thrombosis was increased, especially late stent thrombosis [7]. Therefore, in order to prevent stent thrombosis, prolonged antiplatelet therapy was recommended by clinical guidelines. Then DAPT combination of aspirin with P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) used to reduce the risk of stent thrombosis and adverse cardiac outcomes. However, the optimal duration of DAPT after coronary drug-eluting stent implantation remains debated. It will elevate stent thrombosis if stopping DAPT too early. For the other side, delaying DAPT will increase patients’ burden and reduce patients’ compliance; what’s more, the complication of bleeding will increase and it affects some surgeries. It is a challenge for clinician to balance the advantages and disadvantages.