Deciphering dual antiplatelet therapy in the era of drug-eluting coronary stents

Current Drug Targets

Volumn 10, Issue 6, 2009, Pages 519-529

  Bell, Brendan ^a   Walters, Darren ^a   Spaulding, Christian ^b  

^a THE PRINCE CHARLES HOSPITAL   (Australia)

^b Institut Cochin   (France)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; ANTIVITAMIN K; CILOSTAZOL; CLOPIDOGREL; DIPYRIDAMOLE; HEPARIN; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LOW MOLECULAR WEIGHT HEPARIN; PACLITAXEL; PANTOPRAZOLE; PRASUGREL; PROTON PUMP INHIBITOR; PURINERGIC RECEPTOR BLOCKING AGENT; RAPAMYCIN; THIENOPYRIDINE DERIVATIVE; TICAGRELOR; TICLOPIDINE; WARFARIN;

ACUTE CORONARY SYNDROME; BLEEDING; CEREBROVASCULAR DISEASE; CLINICAL TRIAL; COMBINATION CHEMOTHERAPY; CORONARY ARTERY DISEASE; CORONARY STENT; DOSE RESPONSE; DRUG ACTIVATION; DRUG DOSE INCREASE; DRUG EFFICACY; DRUG ELUTING STENT; DRUG HYPERSENSITIVITY; DRUG MECHANISM; DRUG RECEPTOR BINDING; DRUG SAFETY; DRUG WITHDRAWAL; HEART INFARCTION; HEMATOPOIETIC STEM CELL TRANSPLANTATION; HIGH RISK PATIENT; HUMAN; IN-STENT RESTENOSIS; LIVER DYSFUNCTION; LOADING DRUG DOSE; LOW DRUG DOSE; MEDICAL DECISION MAKING; NEUTROPENIA; PATIENT EDUCATION; PERCUTANEOUS CORONARY INTERVENTION; PERIOPERATIVE PERIOD; PRACTICE GUIDELINE; RASH; RECOMMENDED DRUG DOSE; REVIEW; RISK ASSESSMENT; STAFF TRAINING; STENT THROMBOSIS; SURGICAL RISK; THERAPY DELAY; THROMBOCYTE AGGREGATION INHIBITION; THROMBOEMBOLISM; THROMBOTIC THROMBOCYTOPENIC PURPURA; TREATMENT DURATION; VASCULAR DISEASE;

CORONARY THROMBOSIS; DRUG HYPERSENSITIVITY; DRUG RESISTANCE; DRUG THERAPY, COMBINATION; DRUG-ELUTING STENTS; GRAFT OCCLUSION, VASCULAR; HUMANS; PLATELET AGGREGATION INHIBITORS; WARFARIN;

EID: 68449100258     PISSN: 13894501     EISSN: None     Source Type: Journal    
DOI: 10.2174/138945009788488413     Document Type: Review

References (83)

1. Macaya C, Serruys PW, Ruygrok P, Suryapranata H, Mast G, Klugmann S, et al. Continued benefit of coronary stenting versus balloon angioplasty: one-year clinical follow-up of Benestent trial: Benestent Study Group. J Am Coll Cardiol 1996; 27(2): 255-61.
2. Kimmel SE, Localio AR, Krone RJ, Laskey WK. The effect of contemporary use of coronary stents on in-hopsital mortality. Registry Committee of the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 2001; 37(2): 499-504.
3. Patrono C, Garcia Rodriguez LA, Landolfi R, Baigent C. Low Dose Aspirin for the prevention of atherothrombosis. N Eng J Med 2005; 353(22): 2373-83.
4. Antithrombotic Trialist's Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarct and stroke in high risk patients. BMJ 2002, 324: 71-86.
5. Savi P, Pereillo JM, Uzabiaga MF, Combalbert J, Picard C, Maffrand JP, et al. Identification and biological activity of the active metabolite of clopidogrel. Thromb Haemost 2000; 84(5): 891-6.
6. CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996, 348: 1329-39.
7. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Eng J Med 2006; 354(16): 1706-17.
8. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Eng J Med 2001; 345(7): 494-502
9. Sabatine MS, Cannon CP, Gibson CM, Lopez-Sendon JL, Montalescot G, Theroux P, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Eng J Med 2005; 352 (12); 1179-89.
10. Serruys, PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF, et al. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Eng J Med 1991; 321(1): 13-7.
11. Leon MB, Baim DS, Popma JJ, Gordon PC, Cutlip DE, Ho KK, et al. Stent Anticoagulation Restenosis Study Investigators. A Clinical trial comparing three antothrombotic -drug regimens after coronary artery stenting. N Eng J Med 1998; 339(23): 1665-71.
12. Walters DL, Harding SA, Walsh CR, Wong P, Pomerantsev E, Jang IK. Acute coronary syndrome is a common clinical presentation of in-stent restenosis. Am J Cardiol 2002; 89(5): 491-4.
13. Cutlip DE, Chauhan MS, Baim DS, Ho KK, Popma JJ, Carrozza JP, et al. Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol 2002; 40(12): 2082-9.
14. Hoffmann R, Mintz GS, Dussaillant GR, Popma JJ, Pichard AD Satler LF, et al. Patterns and mechanisms of in-stent restenosis: a serial intravascular ultrasound study. Circulation 1996; 94(6): 1247-54.
15. Cutlip DE, Chhabra AG, Baim DS, Chauhan MS, Marulkar S, Massaro J, et al. Beyond restenosis: five year clinical outcomes from second-generation coronary stent trials. Circulation 2004; 110(10): 1226-30.
16. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O'Shaughnessy C, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349(14): 1315-23.
17. Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002; 346(23): 1773-80.
18. Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, et al. One-year clinical results with the slow-release, polymer-based, paclitaxel-eluting TAXUS stent: the TAXUS-IV trial. Circulation 2004; 109(16): 1942-7.
19. Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalsecot. Drug Eluting stents: an updated meta-analysis of randomized controlled trials. Heart 2006; 92(5): 641-9.
20. Maisel WH. Unanswered Questions - Drug-Eluting Stents and the risk of the Late thrombosis. N Eng J Med 2007: 365(10); 981-4.
21. Cutlip De, Windecker S, Mehran, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 2007; 115(17): 2344-51.
22. Grewe PH, Deneke T, Machraoui A, Barmeyer J, Müller KM. Acute and chronic tissue response to coronary stent implantation: pathological findings in human specimen, J Am Coll Cardiol 2000; 35(1): 157-63.
23. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48(1): 203-5.
24. Bertrand ME, Rupprecht HJ, Urban P, Gershlick AH; CLASSICS Investigators. Double-blind study of the safety of clopidogrel with and without loading dose in combination with aspirin compared with ticlopidine in combination with and without aspirin after coronary stenting; The Clopidogrel Aspirin Stent International Cooperative Study (CLASSICS). Circulation 2000; 102(6): 624-9.
25. Doyle B, Rihal C, O'Sullivan C, Lennon RJ, Wiste HJ, Bell M, et al. Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare metal coronary stents. Circulation 2007; 116(21): 2391-8.
26. Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, et al. Stent Thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103(15): 1967-71.
27. Mauri L, Hsieh W, Massaro JM, Ho KK, D'Agostino R, Cutlip DE. Stent Thrombosis in Randomised Clinical Trials of Drug-Eluting Stents. N Eng J Med 2007; 356 (10): 1020-9.
28. McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T, et al. Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 2004; 364(9444): 1519-21.
29. Luscher T, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, et al.. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation 2007; 115(8): 1051-8.
30. Pfisterer M, Brunner-La Rocca HP, Buser PT, Rickenbacher P, Hunziker P, Mueller C, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents; an observational study of drug eluting stents versus bare metal stents. J Am Coll Cardiol 2006; 48(12): 2584-91.
31. Stone GW, Moses JW, Ellis SG, Schofer J, Dawkins KD, Morice MC, et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N Eng J Med 2007; 356(10): 998-1008.
32. Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare metal stents. N Eng J Med 2007; 356(10): 1030-9.
33. Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, et al. Incidence, predictors, and outcomes of thrombosis after successful implantation of drug-eluting stents. JAMA 2005; 293(17): 2126-30.
34. Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: Results from the PREMIER registry. Circulation 2006; 113(24): 2803-9.
35. Eisenstein EL, Anstrom KJ, Kong DF, Shaw LK, Tuttle RH, Mark DB, et al. Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation. JAMA 2007; 297(2): 159-68.
36. Morice M, Serruys P, Barragan P, Bide C, Van Es GA, Stoll HP, et al. Long-Term clinical outcomes with sirolimus-eluting coronary stents: Five-year results of the RAVEL trial. J Am Coll Cardiol 2007; 50(14); 1299-304.
37. King SB 3rd, Smith SC Jr, Hirshfield JW Jr, Jacobs AK, Morrison DA, Williams DO. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/ AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation 2008;, 117(2): 261-95.
38. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anaesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society for Vascular Surgery. Circulation 2007; 116(17): e418-99.
39. Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000; 35(5): 1288-94.
40. Sharma AK, Ajani AE, Hamwi SM, Maniar P, Lakhani SV, Waksman R, et al. Major noncardiac surgery following stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004; 63(2): 141-5.
41. Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, et al. Clinical outcome of patients undergoing noncardiac surgery in the two months following coronary stenting. J Am Coll Cardiol 2003; 42(2): 234-40.
42. Nasser M, Kapeliovich M, Markiewicz W. Late thrombosis of sirolimus-eluting stents following noncardiac surgery. Catheter Cardiovasc Interv 2005; 65(4): 516-9.
43. Schouten O, vanDomburg RT, Bax JJ, de Jaegere PJ, Dunkelgrun M, Feringa HH, et al. Noncardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with increase in major cardiac events. J Am Coll Cardiol 2007; 49(1): 122-4.
44. Comptom PA, Zankar AA, Adesanya AO, Banerjee S, Brilakis ES. Risk of noncardiac surgery after coronary drug-eluting stent implantation. Am J Cardiol 2006; 98(9): 1212-3.
45. Brilakis ES, Banerjee S, Berger PB. The risk of drug-eluting stent thrombosis with noncardiac surgery. Curr Cardiol Rep 2007; 9(5): 406-11.
46. Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB, Moliterno DJ, et al. Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients with Coronary Artery Stents. A Science Advisory From the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. Circulation 2007; 115(6): 813-8.
47. Burger W, Chemnitius JM, Kneissl GD, Rucker G. Low-dose aspirin for secondary cardiovascular prevention - cardiovascular risks after it perioperative withdrawal versus bleeding risks with it continuation - review and meta-analysis. J Intern Med 2005; 257(5): 399-414.
48. Ferrari E, Benhamou M, Cerboni P, Marcel B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J Am Coll Cardiol 2005; 45(3): 456-9.
49. Eikelboom JW, Hirsh J. Bleeding and management of bleeding. Euro Heart J Supp 2006; 8(supplement G): G38-45.
50. Brilakis ES, Banerjee S, Berger PB. Perioperative management of patients with coronary stents. J Am Coll Cardiol 2007; 49(22): 2145-50.
51. Collet JP, Montalescot G. Premature withdrawal and alternative therapies to dual oral antiplatelet therapy. Euro Heart J Supp 2006; 8(supplement G): G46-52.
52. Serebruany VL, Steinhubl SR, Berger PB, Malnin AI, Bhatt DL, Topol EJ. Variability in platelet responsiveness to clopidogrel among 544 individuals. J Am Coll Cardiol 2005; 45(2): 246-51.
53. Wang TH, Bhatt DL, Topol EJ. Aspirin and clopidogrel resistance: an emerging clinical entity. Eur Heart J 2006; 27(6): 647-54.
54. Oqueli E, Hiscock M, Dick R. Clopidogrel resistance. Heart Lung Circ 2007; 16 Suppl 3: S17-28.
55. Nguyen TA, Diodati JG, Pharand C. Resistance to clopidogrel; a review of the evidence. J Am Coll Cardiol 2005; 45(8): 1157-64.
56. Eccleston D, Brieger D, Walters DL, Rankin J, Mattschoss S, Huynh L, et al. Aspirin resistance predicts an increased risk of in-hospital events in australian patients with acute coronary syndromes: Results from the CARS Study. Abstract. Heart Lung Circ 2008; 17S: S111.
57. Matetzky S, Shenkman B, Guetta V, Shechter M, Bienart R, Goldenberg I, et al. Clopidogrel Resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarct. Circulation 2004; 109(25): 3171-5.
58. Gurbel PA, Bliden KP, Samara W, Yoho JA, Hayes K, Fissha MZ, et al. Clopidogrel effect on platelet reactivity in patients with stent thrombosis. Results of the CREST study. J Am Coll Cardiol 2005; 46(10): 1827-32.
59. Buonamici P, Marucci R, Migliorini A, Gensini GF, Santini A, Paniccia R, et al. Impact of platelet reactivity after clopidogrel administration on drug-eluting stent thrombosis. J Am Coll Cardiol 2007; 49(24): 2312-7.
60. Moliterno DJ, Campbell CL. Unraveling questions surrounding clopidogrel resistance and stent thrombosis. J Am Coll Cardiol 2007; 49(24): 2318-9.
61. Niitsu Y, Jakubowski JA, Sugidachi A, Asai F. Pharmacology of CS-747 (prasugrel, LY640315), a novel, potent antiplatelet agent with in vivo P2Y12 receptor antagonist activity. Semin Thromb Hemost 2005; 31(2): 184-94.
62. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. TRITON-TIMI 38 investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007 15; 357(20): 2001-15.
63. Cannon CP, Husted S, Harrington RA, Scirica BM, Emanuelsson H, Peters G, Storey RF, DISPERSE-2 Investigators. Safety, tolerability, and initial efficacy of AZD6140, the first reversible oral adenosine diphosphate receptor antagonist, compared with clopidogrel, in patients with non-ST-segment elevation acute coronary syndrome: primary results of the DISPERSE-2 trial. J Am Coll Cardiol 2007; 50(19): 1844-51.
64. 2Y12 receptor antagonist, compared with clopidogrel in patients with acute coronary syndrome. J Am Coll Cardiol 2007; 50(19): 1852-6.
65. Goto S. Cilostazol; potential mechanism of action for antithrombotic effects accompanied by a low rate of bleeding. Atheroscler Suppl 2005; 6: 3-11.
66. Douglas JS, Holmes DR, Keriakes DJ, Grines CL, Block E, Ziyad MB, et al. Coronary stent restenosis in patients treated with cilostazol. Circulation 2005; 112: 2826-32.
67. Jeong YH, Lee SW, Choi BR, Kim IS, Seo MK, Kwak CH, et al. Randomized comparison of adjunctive cilstazol versus high maintenance dose clopidogrel in patients with high post-treatment platelet reactivity. J Am Coll Cardiol 2009; 53(13): 1101-9.
68. Lee SW, Park SW, Hong MK, Kim YH, Lee BK, Song JM, et al. Triple versus dual antiplatelet therapy after coronary stenting. J Am Coll Cardiol 2005; 46(10): 1833-7.
69. Lee SW, Park SW, Kim YH, Yun SC,Park DW, Lee CW, et al. Comparison of triple versus dual antiplatelet therapy after drug-eluting stent implantation (from the DECLARE-Long Trial). Am J Cardiol 2007; 100; 1103-8.
70. Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009; 180(7): 713.
71. Bhindi R, Ormerod O, Newton J, Banning AP, Testa L. Interaction between statins and clopidogrel: is there anything clinically relevant? QJM 2008; 101(12): 915-25.
72. Rubboli A, Pasquale G. Triple therapy of warfarin, aspirin and a thienopyridine for patients treated with vitamin K antagonists undergoing coronary stenting. A review of evidence. Intern Emerg Med 2007; 2(3): 177-81.
73. Rubboli A, Halperin JL, Airaksinen KE, Buerke M, Eeckhout E, Freedman SB, et al. Antithrombotic therapy in patients treated with oral anticoagulation undergoing coronary artery stenting. An expert consensus document with focus on atrial fibrillation. Ann Med 2008; 40: 428-36.
74. Orford JL, Fasseas P, Melby S, Burger K, Steinhubl SR, Holmes DR, et al. Safety and efficacy of aspirin, clopidogrel and warfarin after coronary stent placement in patients with and indication for anticoagulation. Am Heart J 2004; 147(3): 462-7.
75. Rubboli A, Colleta M, Sangiorgio P, Di Pasquale G. Antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary stenting: safety and efficacy data from a single center. Ital Heart J 2004; 5(12): 919-25.
76. Khurram Z, Chou E, Minutello R, Bergman G, Parikh M, Naidu S, et al. Combination therapy with aspirin, clopidogrel and warfarin following coronary stenting is associated with a significant risk of bleeding. J Invasive Cardiol 2006; 18 (4): 162-4.
77. Rubboli A, Colletta M, Herzfeld J, Sangiorgio P, Di Pasquale G. Periprocedural and medium-term antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary angiography and intervention. Coronary Artery Dis 2007; 18 (3): 193-9.
78. Urban P, Macaya C, Rupprecht HJ, Kiemeneij F, Emmanuelson H, Fontanelli A, et al. Randomised evaluation of anticoagulation versus antiplatelet therapy after coronary stent implantation in high-risk patients: the Multicenter Aspirin and Ticlodipine Trial After Intracoronary Stenting (MATTIS). Circulation 1998; 98(20): 2126-32.
79. Bertrand ME, Legrand V, Boland J, Fleck E, Bonnier J, Emmanuelson H, et al. Randomised multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting. The Full Anticoagulation versus Aspirin and Ticlodipine (FANTASTIC) study. Circulation 1998; 98(16): 1597-603.
80. Nguyen MC, Lim YL, Walton A, Lefkovits J, Agnelli G, Goodman SG, et al. Combining warfarin and antiplatelet therapy after coronary stenting in the global registry of acute coronary events: is it safe and effective to use just one antiplatelet agent? Euro Heart J 2007; 28(14): 1717-22.
81. Fuster V, Ryden LE, Cannom D, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Mangament of Patients With Atrial Fibrillation: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing committee to Revise the 2001 Guidelines for Management of Patients with Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114(7): e257-354.
82. Silberman S, Neukirch-Stoop C, Steg PG. Rapid Desensitization Procedure for Patients With Aspirin Hypersensitivity Undergoing Coronary Stenting. Am J Cardiol 2005; 95(4): 509-10.
83. Von Tiehl MD, Price MJ, Valencia R, Ludington KJ, Teirstein PS, Simon RA. Clopidogrel Desensitization After Drug-Eluting Stent Placement. J Am Coll Cardiol 2007; 50(21): 2039-43.