Antithrombotic therapy after percutaneous coronary intervention from the Japanese perspective
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REVIEW ARTICLE
Antithrombotic therapy after percutaneous coronary intervention from the Japanese perspective Yuichi Saito1,2 · Yoshio Kobayashi1 · Kengo Tanabe3 · Yuji Ikari4 Received: 6 December 2019 / Accepted: 6 December 2019 © Japanese Association of Cardiovascular Intervention and Therapeutics 2019
Abstract Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in patients with acute and chronic coronary syndrome. Adjunctive antithrombotic therapy following PCI is the cornerstone of pharmacological treatment to prevent ischemic events. Dual antiplatelet therapy, a combination of aspirin and a P2Y12 inhibitor, has been proven as an initial antithrombotic regimen to reduce thrombotic events in patients undergoing PCI. However, the optimal antithrombotic strategy such as appropriate duration of dual antiplatelet therapy and the safe and effective combination of oral anticoagulation with antiplatelet therapy remains under debate. Since Japanese patients have different risk profiles for both thrombotic and bleeding events compared with Western population, optimal antithrombotic regimen may be different. Recently, the evidence in this field has been rapidly evolving and the antithrombotic strategy varies widely in clinical practice. In this clinical expert consensus document, we provide an in-depth review concerning antithrombotic strategies after PCI from Japanese perspective. Keywords Antithrombotic therapy · Percutaneous coronary intervention · Dual antiplatelet therapy · Oral anticoagulation · Guidelines
Introduction Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in patients with acute and chronic coronary syndrome worldwide. There are several sources of thrombotic risk after PCI including prothrombotic conditions associated with underlying patient characteristics, activation of local thrombotic risk by stent and PCI results, and chronic atherosclerotic disease manifestations remote from the procedure. To reduce post-PCI thrombotic events, dual antiplatelet therapy (DAPT), a combination of aspirin and a P2Y12 inhibitor, was introduced in 1990s [1, 2]. * Yuichi Saito [email protected] 1
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1‑8‑1 Inohana, Chuo‑ku, Chiba, Chiba 260‑8677, Japan
2
Yale School of Medicine, New Haven, USA
3
Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
4
Department of Cardiology, Tokai University Hospital, Isehara, Japan
Currently, DAPT is the guideline-recommended cornerstone of antithrombotic therapy for patients undergoing PCI [3–6]. However, adjunctive antithrombotic therapy used to mitigate thrombotic risks should be balanced against bleeding events. The evidence in this field has been rapidly evolving, while the optimal antithrombotic strategy remains under debate and the regimen varies widely in clinical practice. In addition, East Asian patients including Japanese are known to have different risk profiles for both thrombotic and bleeding events c
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