Percutaneous coronary intervention (PCI) with stents is currently the most commonly performed
coronary revascularization procedure; hence, optimizing post-PCI outcomes is important for all
physicians treating such patients.
To review the contemporary literature on optimal medical therapy after PCI.
We performed a comprehensive search of the PubMed and Cochrane Library databases for manuscripts
on medical therapy after PCI, published between 2000 and February 2013. Bibliographies of the
retrieved studies were searched by hand for other relevant studies. Priority was given to data from
large randomized controlled trials, systematic reviews, and meta-analyses. Of the 6852 publications
retrieved, 91 were included.
Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor (eg, ticlopidine,
clopidogrel, prasugrel, ticagrelor) reduces the risk of stent thrombosis and subsequent
cardiovascular events post-PCI (number needed to treat, 33-53) and is the current standard of care.
Aspirin should be continued indefinitely and low dose (75-100 mg daily) is preferred over higher
doses. A P2Y12 inhibitor should be administered for 12 months after PCI, unless the
patient is at high risk for bleeding; however, ongoing studies are assessing the value of shorter or
longer duration of P2Y12 inhibitor administration. In patients with acute coronary
syndromes, prasugrel and ticagrelor further reduce cardiovascular ischemic events compared with
clopidogrel but are associated with higher bleeding risk. If possible, noncardiac surgery should be
delayed until 12 months after coronary stenting. Patients receiving coronary stents who require
warfarin are at high risk for bleeding if they also receive dual antiplatelet therapy. Omission of
aspirin may be advantageous in such patients. Routine platelet function or genetic testing is
currently not recommended to tailor antiplatelet therapy after PCI.
Conclusions and Relevance
Dual antiplatelet therapy remains the cornerstone of medical therapy after PCI. Continuous
advances in pharmacotherapy can further enhance our capacity to improve outcomes in this high-risk
Brilakis ES, Patel VG, Banerjee S. Medical Management After Coronary Stent ImplantationA Review. JAMA. 2013;310(2):189–198. doi:10.1001/jama.2013.7086