Herz
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More and more patients are treated with antiplatelet drugs today. In this context a sufficient inhibition of platelet aggregation, on the one hand, is of essential importance to the efficiency of prophylaxis of myocardial and cerebral infarction and to avoiding thrombosis of drug-eluting stents. On the other hand, this medication can result in an increased risk of perioperative bleeding. In both situations control of the efficiency of therapy or rather the assessment of the impairment of hemostasis is of vital importance. ⋯ Due to their easy handling the described POC devices are applicable to perioperative coagulation management as well as during and after coronary intervention or to monitoring of platelet function in cardiologic practice. They enable a quick assessment of platelet function and an individually guided therapy.
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Percutaneous coronary intervention (PTCA, PCI) is the most frequently used therapy for the treatment of stenoses or occlusions of coronary arteries. In Germany, six PCIs are performed for every coronary bypass surgery. Today, stents are implanted in over 80% of PCIs to improve the acute and long-term results. ⋯ If a DES was nevertheless implanted, triple therapy (coumadin, ASA, and clopidogrel) is recommended--with an INR (International Normalized Ratio) target of 2.0, possibly adding a proton pump inhibitor. In case of nondeferrable surgery, dual platelet inhibition should be continued, if possible (like dental extractions), or perioperatively converted to a small-molecule glycoprotein IIb/IIIa inhibitor--under in-hospital survey. Further developments of next-generation DES with different drugs, modified release kinetics, specifically abluminal drug release or bioabsorbable polymers or absorbable stents are necessary, in order to reduce the duration of dual platelet inhibition to the range of BMS--but maintaining the well-established antiproliferative effects of DES.