Editorial [Hot Topic: Drugs in Interventional Cardiology Executive Editor: Peter W. Radke ]

The success of percutaneous coronary interventions depends on a number of variables. Clearly, all starts with appropriate patient and lesion selection for an interventional approach as compared to medical therapy or bypass surgery. A deep understanding of the sometimes complex material as well as broad experience in handling the available technology is also extremely important. A third variable relates to adjunct anticoagulant (antiplatelet and antithrombotic) pharmacological interventions. In recent years, use of acetylsalicylic acid (ASA), thienopyridines and- to a lesser extent, glycoprotein IIb/ IIIa receptor antagonists- has been turned out as the cornerstone of antiplatelet therapy. Regarding antithrombotic interventions, the picture is not so clear. Historically, unfractionated heparin (UFH) has been used for a long time in most centers worldwide. In recent years, however, limitations of UFH like the occurence of heparin- induced thrombocytopenia (HIT) have been disclosed. Furthermore, as the prognostic importance of periprocedural bleeding events has become apparent, the search for alternatives to UFH has become even more important. During the last decade, a number of new antithrombotic drugs have been developed and clinically evaluated, but there is also more to come. In this edition of “Drugs in interventional cardiology”, a variety of antithrombotic drugs in the context of percutaneous coronary interventions will be discussed. In the first article, Susanne Alban will provide an overview on the pharmacology of different antithrombotic drug classes [1]. Thereafter, the specific problem of anticoagulation in patients with confirmed or suspected HIT will be adressed by Alexander Joost and co- workers [2], before two manuscripts will focus on anticoagulation in the large number of patients with acute coronary syndromes using factor Xa inactivation [3] or direct thrombin inhibition [4]. Due to restricted budgets in most health care systems as well as different reimbursement policies between countries and even between states, pharmacoeconomic considerations of anticoagulants are relevant and will be discussed in the last manuscript [5]. I would like to thank all authors for their contribution. References [1] Alban S. Pharmacological strategies for inhibition of thrombin activity. Curr Pharm Des 2008; 14(12): 1152-1175. [2] Joost A, Kurowski V, Radke PW. Anticoagulation in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary angiography and interventions. Curr Pharm Des 2008; 14(12): 1176-1185. [3] Barantke M, Bonnemeier H. Factor Xa Inactivation in Acute Coronary Syndrome. Curr Pharm Des 2008; 14(12): 1186-1190. [4] Hartmann F. Safety and Efficacy of Bivalirudin in Acute Coronary Syndromes. Curr Pharm Des 2008; 14(12): 1191-1196. [5] Houston S, Hawkins SA. Pharmacoeconomics of Anticoagulants in Acute Coronary Syndrome and Percutaneous Coronary Intervention. Curr Pharm Des 2008; 14(12): 1197-1204.