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Review
. 2021 May 27:15:e10.
doi: 10.15420/usc.2020.37. eCollection 2021.

Antithrombotic Therapy in Chronic Total Occlusion Interventions

Iosif Xenogiannis  1 , Charalambos Varlamos  1 , Despoina-Rafailia Benetou  1 , Dimitrios Alexopoulos  1
Affiliations
Review

Antithrombotic Therapy in Chronic Total Occlusion Interventions

Iosif Xenogiannis et al. US Cardiol. .

Abstract

Chronic total occlusion (CTO) recanalization is among the most complex subsets of coronary interventions. Hence, optimum peri- and postprocedural anticoagulation and antiplatelet therapy is key for the achievement of successful revascularization and reduction of major adverse cardiovascular outcomes in patients undergoing CTO percutaneous coronary intervention (PCI). Unfractionated heparin is still considered the gold standard anticoagulant because its action can be reversed by protamine administration, with bivalirudin being reserved mainly for patients with heparin-induced thrombocytopenia. However, small studies comparing unfractionated heparin with bivalirudin in CTO interventions have shown similar outcomes. Glycoprotein IIb/IIIa inhibitors should, in general, be avoided. Aspirin in combination with clopidogrel for 6-12 months is the standard post CTO PCI dual antiplatelet regimen. For the most complex cases, clopidogrel can be substituted by a more potent P2Y12 inhibitor, namely ticagrelor or prasugrel.

Keywords: Chronic total occlusion; IIb/IIIa inhibitors; anticoagulation; antiplatelets; aspirin; bivalirudin; clopidogrel; percutaneous coronary intervention; prasugrel; ticagrelor; unfractionated heparin.

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Conflict of interest statement

Disclosure: DA has received lecturing honoraria/advisory board fees from AstraZeneca, Bayer, Boehringer Ingelheim, Pfizer, Medtronic, Biotronik, and Chiesi Hellas; and is Guest Editor of the antithrombotics in high-risk PCI special collection for US Cardiology Review; this did not influence peer review. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Anticoagulation and Antiplatelet Therapy in Chronic Total Occlusion Interventions
Figure 2:
Figure 2:. Events in Patients Receiving Dual Antiplatelet Therapy for ≤12 Months Versus >12 Months
See this image and copyright information in PMC

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