The role of antiplatelet drugs in preventing thrombosis caused by coronary stent re-occlusion

The article is professionally consulted by MSc Nguyen Van Phong - Internal Medicine and Cardiology Interventionist, Cardiovascular Center - Vinmec Times City International General Hospital. The doctor has more than 15 years of experience in the field of cardiology.

Coronary stenting is one of the great advances in the field of interventional cardiology, helping to reduce the rate of restenosis and vascular occlusion after balloon angioplasty. However, the nature of this technique is to place a metal framework (stent) in the artery, so the stent will increase the risk of blood clot formation, which will most likely lead to stent re-occlusion.
The frequency of stent thrombosis is about 0.5 - 2% and is a serious complication after coronary intervention, increasing the risk of death from myocardial infarction. Mortality rates can be as high as 45%.
Factors affecting thrombus formation after coronary stenting:
Slow formation of vascular endothelium lining the stent lumen; Inflammatory response to stent material; Hypersensitivity to stent materials.

Learn about antiplatelet drugs in the treatment of coronary artery disease to prevent thrombosis causing coronary stent occlusion.
2.1 Antiplatelet drugs Antiplatelet drugs reduce the ability of platelets to aggregate, inhibit the process of thrombus formation. The commonly used antiplatelet drugs are:
Aspirin : is a common antiplatelet drug. Using aspirin with a P2Y12 receptor inhibitor is a fairly widely used therapy; P2Y12 receptor blockers include clopidogrel, prasugrel, and ticagrelor. Details of the drugs are as follows: Clopidogrel: is the most studied active P2Y12 inhibitor. Aspirin and clopidogrel are widely used to prevent stent thrombosis after coronary intervention. However, about 15-48% of patients have poor response to clopidogrel; Prasugrel: may have a faster onset of action, is more effective than clopidogrel. However, this drug increases the risk of bleeding; Ticagrelor: has a stronger, more stable platelet inhibitory effect than clopidogrel. 2.2. The role of antiplatelet drugs to prevent thrombosis To prevent thrombosis in stents, it is necessary to:
Optimal coronary intervention: stenting to cover all lesions, placing stents close to the coronary walls , there is no residual stenosis or coronary dissection at the edge of the stent. In cases where suboptimal stenting is suspected, intravascular ultrasound will play an important role; Use dual antiplatelet drugs before coronary intervention and maintain these drugs after intervention.

Drug therapy after coronary stenting, especially antiplatelet agents, plays a very important role in reducing the risk of stent thrombosis. Specifically, patients undergoing coronary intervention should receive aspirin in combination with a P2Y12 inhibitor antiplatelet agent for at least 6 months or 1 year after the intervention to reduce the risk of myocardial infarction complications. heart or death.

3.1. Duration of drug use Duration of use of dual antiplatelet drugs (if there is no history of heavy bleeding, no need for anticoagulants) is 12 months; For patients at high risk of bleeding or who need to stop taking the drug early, the duration of drug therapy should still be at least 30 days (for those with conventional stents) and 6 months (for those with drug-eluting stents). 3.2. Long-term drug use is especially recommended for the following cases:
Patients after complex coronary intervention (intervention for saphenous vein bypass, intervention for bifurcation, common trunk) left coronary artery or persistent lesions); Patients with suboptimal intervention results (coronary stents do not cover all lesions, and residual stenosis); The patient received a first-generation drug-eluting stent; Patients with a history of blood clots causing stent re-occlusion or an embolic event within 12 months (despite dual antiplatelet therapy). It should be noted that people with a history of asthma, people with peptic ulcers, people at risk of bleeding, kidney failure, liver failure, pregnant women, etc. need to be cautious when using antiretroviral drugs. platelet aggregation.

Thromboembolism causing coronary stent re-occlusion is an uncommon complication but has a high rate of myocardial infarction and mortality. To prevent this complication, intervention should be optimized and prolonged antiplatelet therapy should be maintained after the procedure. Besides, choosing a good reputable medical facility, modern facilities and a team of qualified doctors and nurses is also very important.
Cardiovascular Center - Vinmec International General Hospital is effectively and safely applying coronary angiography, balloon angioplasty, angioplasty and coronary stenting. The entire procedure of examination and treatment, coronary intervention at Vinmec is carried out by a team of qualified, experienced and well-trained medical doctors, so it brings good treatment results, with limited treatment. risk of restenosis after coronary stenting. Moreover, at Vinmec, all instruments in the intervention procedure, consumables are used once, not reused to ensure the safest for the patient.
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