Antiplatelet and anticoagulant therapy in patients undergoing percutaneous transluminal coronary angioplasty
Review published in Cardiology clinics (1994)
Abstract
Although coronary angioplasty has been in clinical use for only 15 years, continued refinements in technique, instrumentation, and adjunctive therapy have led to high initial success rates despite broader patient selection and the increasing complexity of lesions attempted. Antiplatelet therapy in the form of 80 to 325 mg of aspirin begun before the procedure has been demonstrated to be of benefit in decreasing the acute complication rate associated with PTCA. In the future, this beneficial effect may be augmented by the addition of monoclonal antibody inhibitors to platelet membrane glycoprotein IIB/IIIa, possibly at the expense of a mild-to-moderate increase in bleeding complications. Although routine prolonged antithrombotic therapy has not been useful after uncomplicated angioplasty, there is evidence that antithrombotic therapy with heparin for 1 or more days before angioplasty will benefit patients with unstable angina or evidence of thrombus on angiography. Although patients with thrombus or coronary dissection after the procedure probably also benefit from extended heparin therapy, most trials have specifically excluded these patients from study. More potent and specific antithrombin and antiplatelet agents are currently being investigated in human trials and may further lower acute complication rates. Although platelets, thrombin, and mural thrombosis have all been implicated as factors in restenosis, the process itself remains incompletely understood, and no therapy has been shown to be of benefit in humans. The specific platelet IIb/IIIa inhibitors, hirudin, hirulog, and factor Xa inhibitors have all shown promise in animal models of restenosis, and ongoing or planned trials will define their efficacy in humans.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Although coronary angioplasty has been in clinical use for only 15 years, continued refinements in technique, instrumentation, and adjunctive therapy have led to high initial success rates.
Why This Matters for Hirudotherapy
This review examines the role of antiplatelet and anticoagulant therapies—including aspirin, heparin, and emerging agents—in reducing acute complications after coronary angioplasty. Hirudin, along with hirulog and factor Xa inhibitors, is noted as having "shown promise in animal models of restenosis," with ongoing or planned human trials anticipated to define their efficacy. The abstract emphasizes that despite platelets, thrombin, and mural thrombosis being implicated in restenosis, no therapy had yet demonstrated benefit in humans at the time of writing. This is of indirect relevance to ASH's domain as it positions hirudin among emerging antithrombotic agents under active clinical investigation. The key caveat is that this is a review article, hirudin is mentioned only in passing, and the abstract provides no original data or specific findings beyond noting its promise in animal models.
Citation
Added to ASH library: May 27, 2026 · Site last updated: June 18, 2026