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[Treatment of anti-thrombotic therapy in coronary artery disease].

Anti-platelet therapy is well known to reduce coronary events such as mortality, myocardial infarction and improving the prognosis in patients with coronary artery disease. In addition, dual antiplatelet therapy(DAPT) using aspirin and thienopyridine (usually clopidogrel) is a standard regimen after stenting as one of the standard therapy of revascularization. Recently, drug eluting stents (DES) were developed for preventing restenosis after bare metal stent; however, stent thrombosis after DES has been increasing for long-term period. Polymorphism of CYP2C19 affecting clopidogrel activity might be one cause of such problems. New anti-platelet drugs have been developed to overcome this point. For preventing stent thrombosis, long-term DAPT is necessary right now and lead the occasional bleeding complications. On the other hands, novel oral anti-coagulant drugs have been used for the stroke prevention in patient with atrial fibrillation instead of antivitamin K drug. Several clinical trials are now ongoing to investigate the utility of NOAC in patients with coronary artery disease. In this review, anti-thrombotic treatment for the patients with coronary artery disease from the past to the future is discussed.