Changing anticoagulation regimens for intracoronary stenting

Traditionally, intensive anticoagulant and antiplatelet regimens have been recommended before, during, and after stent implantation. The primary rationale for these intensive regimens was the prevention of subacute thrombosis, thought to be due largely to the 'thrombogenicity' of the metallic devices. Two recent developments changed this situation: (1) the recognition that bleeding and vascular complications are more common after stent implantation than is subacute closure; and (2) the finding, through the more widespread use of intravascular ultrasound, that stent implantation employing conventional techniques and approaches is often suboptimal. Many investigators reasoned that these suboptimal results, rather than the particular anticoagulant/antiplatelet protocol used, were responsible for subacute closure, and accordingly, changed their anticoagulant/antiplatelet programs to less intensive regimens. These less stringent anticoagulant/antiplatelet regimens have not been rested in prospective, randomized trials, but appear safe based on an increasingly large patient experience.