Contemporary antithrombotic treatment after coronary stenting in patients with indication for long-term...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine is standard after percutaneous coronary intervention with stent implantation (PCI-S).
• Optimal antithrombotic management for patients requiring long-term oral anticoagulation (OAC) alongside PCI-S is not well-defined.
• This patient subgroup is projected to increase, highlighting the need for evidence-based treatment guidelines.

Purpose of the Study:

• To evaluate current management strategies for patients undergoing PCI-S who also require OAC.
• To assess the safety and efficacy of different antithrombotic regimens in this complex patient population.
• To identify gaps in knowledge and guide future research directions.

Main Methods:

• A systematic literature review was conducted.
• Studies reporting on antithrombotic strategies in patients with OAC undergoing PCI-S were analyzed.
• Data on treatment variations, safety (bleeding), and efficacy (thrombosis) were extracted.

Main Results:

• Significant variability exists in adopted antithrombotic strategies.
• Common regimens included OAC substitution, addition of single antiplatelet, or triple therapy (OAC, aspirin, thienopyridine).
• Observed 30-day rates for major bleeding were 3-7%, and thrombotic complications were 4%, indicating suboptimal outcomes.

Conclusions:

• Current antithrombotic treatments for OAC patients undergoing PCI-S demonstrate suboptimal safety and/or efficacy.
• The optimal therapeutic approach remains undefined.
• Large-scale registries and clinical trials are essential to establish best practices for this increasing patient cohort.