Stent thrombosis: role of compliance and nonresponsiveness to antiplatelet therapy.

Sinai Center for Thrombosis Research, Baltimore, Maryland, USA.
Reviews in cardiovascular medicine (Impact Factor: 0.56). 01/2007; 8 Suppl 1:S19-26.
Source: PubMed


Percutaneous coronary intervention with drug-eluting stents has revolutionized the management of patients with symptomatic coronary artery disease. Although this strategy significantly reduces the incidence of restenosis and repeat revascularization, concern has been raised about an increased frequency of late stent thrombosis with drug-eluting stents compared with bare-metal stents. The mechanism of stent thrombosis remains unclear, and various hypotheses have been described. Platelets are believed to play a pivotal role in the development of stent thrombosis, with pathological studies demonstrating an abundance of platelets within the occlusive thrombi. Premature discontinuation and nonadherence to antiplatelet therapy are considered important risk factors for late stent thrombosis. Early identification of vulnerable patients and definition of the role of antiplatelet nonresponsiveness in the development of stent thrombosis should be the focus of future diagnostic and therapeutic strategies.

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    ABSTRACT: An estimated 71 million individuals in the United States are currently diagnosed with cardiovascular disease (CVD). If untreated, CVD conditions such as systemic hypertension, coronary artery disease, and heart failure will have potentially serious and often fatal outcomes. Numerous clinical trials have established a variety of evidence-based medications that are efficacious in the treatment of CVD. These drugs will be ineffective, however, if patients have trouble adhering to their prescribed regimens. In patients with hypertension or heart failure, or in those who have suffered a myocardial infarction, poor adherence to therapies has been linked to a variety of problems, including poor blood pressure control, rehospitalization, and increased healthcare resource utilization. Both the asymptomatic nature of some forms of CVD and the high pill burden associated with certain therapies have been linked to poor adherence. Reducing pill burden through the use of once-daily formulations has proven valuable in improving adherence to evidence-based therapies. This review will discuss the impact of adherence to prescribed therapies for CVD, outline common barriers to adherence, and demonstrate the value of once-daily dosing regimens for improved patient adherence.
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