Antiplatelet Treatment for Catheter-Based Interventions in High-Risk Patients: Current Guidelines and Expert Opinion

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• Catheter-based interventions for coronary artery disease (CAD) and aortic valve disease have advanced treatment but carry risks of thromboembolism and bleeding.
• Current guidelines for antithrombotic therapy after percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) lack specific recommendations for high-risk patients.
• Optimal antiplatelet strategies for complex PCI with atrial fibrillation and TAVR remain challenging, often relying on expert consensus.

Purpose of the Study:

• To review the current state of antithrombotic therapy in patients undergoing PCI and TAVR.
• To focus on strategies for managing patients at high risk for both thromboembolic events and bleeding complications.
• To provide evidence-based recommendations for clinical practice regarding antithrombotic treatment in these challenging patient populations.

Main Methods:

• Comprehensive literature review of existing guidelines and clinical evidence.
• Analysis of antithrombotic treatment strategies, including antiplatelet agents and anticoagulants.
• Focus on patient subgroups with complex coronary artery disease, atrial fibrillation, and those undergoing TAVR.

Main Results:

• Significant gaps exist in evidence-based recommendations for high-risk patients undergoing PCI and TAVR.
• The optimal balance between preventing thromboembolic events and minimizing bleeding complications is a key clinical challenge.
• Current antiplatelet therapy post-TAVR is largely based on expert opinion rather than robust clinical trial data.

Conclusions:

• There is a critical need for improved, evidence-based guidelines for antithrombotic therapy in patients undergoing PCI and TAVR.
• Special attention must be given to patients with elevated risk for thromboembolic or bleeding complications.
• Further research is warranted to establish optimal antithrombotic regimens for complex cases and TAVR patients.