Individualized antithrombotic therapy in high risk patients after coronary stenting. A double-edged sword between...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the standard treatment post-coronary stent implantation to prevent stent thrombosis.
• Individual patient risk factors and procedural characteristics necessitate personalized DAPT strategies regarding duration and intensity.

Purpose of the Study:

• To review current literature and guidelines for stratifying patients who may benefit from individualized antithrombotic regimens.
• To address the limitations of conventional DAPT in specific high-risk patient subgroups.

Main Methods:

• Literature review of evidence-based guidelines and randomized trials.
• Analysis of factors influencing stent thrombosis risk and bleeding complications.
• Stratification of patient collectives for tailored antithrombotic therapy.

Main Results:

• Current DAPT duration recommendations vary widely (four weeks to one year) based on clinical and procedural factors.
• Evidence is insufficient for conventional DAPT in patients requiring anticoagulation, perioperative antiplatelet withholding, or those with clopidogrel low response.
• Individualized antithrombotic strategies are needed for specific high-risk patient groups.

Conclusions:

• Personalized DAPT is essential to optimize the benefit-risk ratio of antithrombotic therapy after coronary stenting.
• Further research and tailored approaches are required for high-risk populations to improve outcomes.
• Stratification of patients can guide individualized antithrombotic regimens, balancing efficacy and safety.