Current controversies in PCI pharmacotherapy

Area of Science:

• Cardiology
• Pharmacology
• Vascular Biology

Background:

• Coronary artery disease (CAD) and atherothrombosis involve complex interactions of anatomical, cellular, and molecular factors.
• Revascularization partially addresses ischemic heart disease; pharmacological therapies targeting atherothrombosis are essential for preventing complications.
• Antithrombotic therapies aim to balance anti-thrombotic efficacy with bleeding risk, a challenge in clinical practice.

Purpose of the Study:

• To review current debates and controversies in acute and chronic anticoagulant and antiplatelet therapies for patients undergoing PCI.
• To emphasize the need for individualized pharmacotherapy selection based on ischemic and hemorrhagic risk.
• To highlight the importance of optimizing antithrombotic strategies in the context of PCI.

Main Methods:

• Review of current literature on antithrombotic pharmacotherapies.
• Analysis of the interplay between pharmacological agents, CAD phenotype, and comorbidities.
• Discussion of individualized risk assessment for PCI pharmacotherapy selection.

Main Results:

• Optimal antithrombotic therapy presents a complex challenge due to the need to maximize efficacy while minimizing bleeding risk.
• Patient-specific factors, including clinical phenotype and comorbidities, significantly influence treatment decisions.
• A shift towards customized patient care is necessary given the availability of diverse pharmacologic agents and diagnostic tools.

Conclusions:

• Individualized evaluation of ischemic and hemorrhagic risk is paramount for selecting optimal acute and chronic PCI pharmacotherapy.
• Antithrombotic therapy selection requires careful consideration of potency, duration, and adherence.
• Effective management of atherothrombosis necessitates a tailored approach to antithrombotic treatment in PCI patients.