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Canadian Journal of Cardiology

The Evolution of Anticoagulation for Percutaneous Coronary Intervention: A 40-Year Journey

      Abstract

      The selection of antithrombotic strategies continue to be of utmost importance during percutaneous coronary intervention (PCI) and have evolved over the past 40 years. Although the backbone of therapy during PCI continues to be a combination of oral antiplatelets and parenteral anticoagulants, a variety of different approaches have been tested over time. In particular, different choices of anticoagulation management have been tested in the stable ischemic heart disease and acute coronary syndrome setting. Evaluation of alternative regimens in the quest to balance ischemic and bleeding risk have undoubtedly improved patient care with PCI. In the current review we highlight the evolution of evidence-based therapeutic options over the past 40 years from the beginning of coronary angioplasty to contemporary PCI. We provide insight into future therapeutic options and provide a contemporary overview of anticoagulation choices for patients who require PCI on the basis of up-to-date evidence balancing ischemic and bleeding risk and according to clinical presentation.

      Résumé

      Les stratégies antithrombotiques pour les interventions coronariennes percutanées (ICP) ont grandement évolué au cours de 40 dernières années, et la sélection de la bonne option demeure de la plus haute importance. Bien que l’association d’antiplaquettaires par voie orale et d’anticoagulants par voie parentérale continue d’être le traitement phare lors des ICP, d’autres approches ont été mises à l’essai au fil des années. Plus particulièrement, plusieurs options d’anticoagulothérapie ont été proposées, à la fois dans les cas de cardiopathie ischémique stable et du syndrome coronarien aigu. L’évaluation des différents schémas dans le but de soupeser les risques d’ischémie et de saignement a mené sans l’ombre d’un doute à l’amélioration des soins offerts aux patients faisant l’objet d’une ICP. Notre article de synthèse présente l’évolution des options thérapeutiques basées sur les données probantes recueillies au cours de 40 dernières années, des balbutiements de l’angioplastie coronarienne à l’ICP contemporaine. À la lumière des données probantes les plus récentes, nous présentons un survol des options thérapeutiques à venir et des choix actuels d’anticoagulothérapie pour les patients qui subissent une ICP en tenant compte de l’équilibre entre les risques d’ischémie et de saignement selon le tableau clinique des patients.
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