Parenteral Antiplatelet Agents in PCI

Percutaneous coronary intervention (PCI) has a central role in the management of patients with stable or unstable coronary artery disease. To maintain the immediate results of PCI and prevent complications and recurrence of thrombotic events, inhibition of platelet activity is essential. Parenteral antiplatelet agents include glycoprotein IIb/IIIa inhibitors (GPI) and cangrelor, which is a reversible inhibitor of the platelet adenosine diphosphate receptor (P2Y12). These agents have a useful pharmacologic profile because of their ability to reach rapid antiplatelet effect and overcome the limitations of oral antiplatelet agents. This chapter examines the contemporary evidence on the use of parenteral antiplatelet agents in PCI, reporting current recommendations for best clinical practice. Some older trials before the era of dual antiplatelet therapy showed that patients undergoing PCI experienced lower ischemic events, mainly driven by reduction in myocardial infarction (MI) when receiving adequately dosed GPI combined with unfractionated heparin (UFH) instead of UFH alone.