This book considers paradigmatic clinical cases in order to cast light on key issues relating to elective or emergency stent implantation and the use of oral anticoagulation (OAC) in patients with atrial fibrillation. The topics addressed include the optimal periprocedural antithrombotic treatment (uninterrupted vs interrupted OAC, intraprocedural use of heparin and glycoprotein IIb/IIIa inhibitors, etc.), the most appropriate type of stent (bare metal vs drug eluting vs “bioactive”), the optimal regimen (e.g., triple therapy of OAC, aspirin, and clopidogrel vs the combination of OAC and a single antiplatelet agent), and the most suitable duration of the antithrombotic treatment prescribed at discharge (1 vs 6–12 months). The case-based management recommendations will be of wide practical value in the current health care context, where percutaneous coronary intervention is available even to patients with relevant co-morbidities, such as those warranting long-term OAC, and the indications for OAC are much broader than in the past. The book will appeal especially to clinical and interventional cardiologists, internal medicine specialists, hematologists, and family physicians and will also be of interest to cardiology and internal medicine residents and fellows.

This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

This practical handbook is based on an internal working manual developed by staff and fellows at Mount Sinai Heart Cardiovascular Catheterization Laboratory, renowned for its high-volume and low complication complex coronary procedures. The Practical Handbook of Interventional Cardiology captures the knowledge and methodological know-how from leaders in interventional cardiology, it intends to guide users in a stepwise, methodical and practical approach through various cardiac interventional procedures in order to achieve maximum patient safety and improved outcomes. From patient selection, preoperative work-up, setting up equipment to step-by-step illustrations of various procedural details and troubleshooting, this handbook captures all the details necessary to perform the simplest to the most complex cardiac interventions. The book is designed for cardiologists and trainees who desire an efficient way to review the steps of various cardiac interventional procedures and a quick, reliable reference for everyday use.

Clinical application of antithrombotic therapy in both arterial disease (acute coronary syndromes, acute MI, peripheral arterial disease, valvular heart disease, atrial fibrillation) and venous disease, (venous thromboembolic disease and pulmonary embolism). Results of major clinical trials and their implications for clinical practice.

Coronary stenting is the most commonly used method of myocardial revascularization, with approximately 2 million stents implanted in 2004 throughout the world. The development of drug eluting stents has resulted in very low rates of repeat intervention and will further increase the scope for percutaneous coronary intervention. The evidence from large randomized trials is generally accepted to be the gold standard source of information for patient care in interventional cardiology. However, it is well recognized that information from these trials is frequently insufficient to guide the wide-ranging clinical situations found in routine practice. In this context, decision-making is often based on a composite of information from multiple clinical studies, pathophysiological considerations and importantly, personal experience or 'gut-feeling'. This book, written by internationally recognized experts in their field, provides clear and concise recommendations regarding various challenging clinical situations facing the interventional cardiologist on a daily basis.

This title will be presented as highly practical information pn pharmaceutical antiplatelet and anticoagulation therapy, written in a quick-access, no-nonsense format. The emphasis will be on a just-the-facts clinical approach, heavy on tabular material, light on dense prose. The involvement of the ISCP will ensure that the best quality contributors will be involved and establish a consistent approach to each topic in the series. Each volume is designed to be between 120 and 250 pages containing practical illustrations and designed to improve understand and practical usage of cardiovascular drugs in specific clinical areas.

Current guidelines recommend that patients be given dual antiplatelet therapy (DAPT; combination of a P2Y12 inhibitor [clopidogrel, prasugrel, or ticagrelor] with acetylsalicylic acid [ASA]) ranging from six months to 12 months following percutaneous coronary intervention (PCI) with stenting, with the aim of preventing stent thrombosis and major adverse cardiac and cerebrovascular events (MACCEs). However, debate is ongoing about the optimal duration of DAPT; importantly, patient characteristics may be an important factor in treatment duration decisions. In some settings, DAPT for even less than six months may be appropriate (e.g., patients with high risk of bleeding), while other patients may derive greater benefit from extended DAPT (e.g., patients with high risk of stent thrombosis and low risk of bleeding). Previous reviews have reported an increased risk of death among patients who received DAPT for more than 12 months following PCI with stenting, but whether this risk is common across all patient subgroups is unclear. Previous systematic reviews (SRs) have attempted to determine the optimal duration of DAPT; however, there is a paucity of data on the impact of specific patient characteristics or type of P2Y12 inhibitor on the effect estimate. One SR reported that extending DAPT beyond 12 months reduced the risk of stent thrombosis in patients without, but not with, acute coronary syndrome (ACS); however, no significant differences were reported in the risk of cardiovascular (CV) death or myocardial infarction (MI). A recent network metaanalysis (NMA) found that among patients randomized to ticagrelor, prasugrel, or clopidogrel, the risk of major adverse cardiac events and MI were lower with both ticagrelor and prasugrel compared with clopidogrel. Shah et al. reported a reduced risk of all-cause and CV death among patients randomized to ticagrelor compared with clopidogrel; however, whether these results are consistent at all durations of DAPT is unknown. To make appropriate decisions, clinicians require a transparent and comprehensive review of the evidence to evaluate the potential benefits and harms associated with extending DAPT beyond 12 months after stenting to potentially personalize therapy and reach best patient outcomes. Such information may also inform P2Y12 inhibitor reimbursement policies by insurers because such policies may be limited to 12 months, in particular in the public sector. In this study, we will evaluate the comparative clinical effectiveness of different DAPT durations by performing an SR to assess the benefits and harms associated with extending DAPT beyond 12 months following PCI with stenting. We will also investigate the effect of extended DAPT in clinically relevant patient subgroups, including age, history of MI, ACS at presentation, diabetes, and smoking status, and the impact of individual P2Y12 inhibitors. Of note, the patient subgroups were selected based on the clinical components of the DAPT Score combined with consideration of findings from a recent clinical review that found different effects between shorter and longer DAPT duration for some subgroups; the selected subgroups were chosen because statistically significant differences were observed in key clinical outcomes when extended DAPT was used. In addition, we will evaluate the comparative cost-effectiveness of different DAPT durations; results from the clinical review will be used to inform clinical input for the economic evaluation.

The perioperative management of antiplatelet therapy for patients with coronary stents remains unclear. This review was requested to assess the evidence for the following key questions: among patients on APT in conjunction with percutaneous coronary intervention (PCI) undergoing elective surgical procedures, including intraocular procedures, what are the benefits and harms of holding APT prior to surgery? How does benefit/risk vary by the timing of discontinuation? How does benefit/risk vary by type of surgical procedure, including intraocular procedures? How does benefit/risk vary by type of APT? How does benefit/risk vary by the timing of resuming APT? We conducted searches in PubMed, Web of Science, and Scopus from inception of each database to 12/17/2015. Thirteen observational studies reported the details of preoperative APT, perioperative APT management, and outcomes, in sufficient detail to assess their association. In general, within studies the bleeding outcomes were reported at higher rates than the MACE outcomes, timing of cessation, bridging, restarting therapy, and type of APT. Additionally, the varied range of invasiveness of the procedure, from skin excisions to major thoracic cases, contributes to the operative bleeding risk and MACE risk, yet many studies lacks sufficient detail to assess the impact of procedure on the outcomes. The results also suggest that clinical factors other than perioperative APT management may be in part responsible for MACE and bleeding outcomes. It is likely that a clinical trial of large size would be needed to more definitely provide evidence about this clinical decision.

Antiplatelet therapy is a very important part of medical therapy for patients after acute coronary syndrome (ACS) as well as in a stable coronary artery disease (CAD). The use of antiplatelet therapy after coronary artery bypass graft surgery (CABG) still is a controversial theme in daily clinical practice. While guidelines referring to dual antiplatelet therapy (DAPT) after ACS with proceeding percutaneous coronary intervention (PCI) are uniform, there are doubts regarding DAPT after CABG, especially in setting of chronic coronary syndrome (CCS). Recommendations are mostly based on expert opinion and not on multiple randomized controlled trials (RCT) or meta-analyses. Resistance to aspirin (acetylsalicylic acid, ASA) or other antiplatelet drugs is known after CABG, and further RCTs are needed to assess the effect on clinical outcome as well as the role of DAPT after CABG.