Optimal Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention: A Focused Review on High...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Dual antiplatelet therapy (DAPT) is standard after percutaneous coronary intervention (PCI) for coronary artery disease (CAD) to prevent stent thrombosis.
• Increased DAPT duration correlates with higher bleeding risk and mortality, especially in elderly patients with comorbidities.
• Advancements in drug-eluting stents (DES) have reduced thrombotic risk, enabling shorter DAPT durations.

Purpose of the Study:

• To review evidence for optimizing antithrombotic therapy in high bleeding risk (HBR) patients undergoing PCI.
• To shift focus from solely reducing thrombotic risk to safely minimizing bleeding risk post-PCI.
• To guide clinical decisions balancing bleeding and thrombotic risks in CAD patients.

Main Methods:

• Literature review of clinical studies and guidelines on DAPT and antithrombotic therapy.
• Analysis of factors influencing bleeding and thrombotic risk in CAD patients.
• Focus on evidence relevant to high bleeding risk patient stratification.

Main Results:

• Current guidelines emphasize HBR patient identification for tailoring antithrombotic therapy.
• Balancing bleeding and thrombotic risks is paramount for optimal patient outcomes.
• Evidence supports adjusting therapy duration and agents based on individual risk profiles.

Conclusions:

• Optimizing antithrombotic therapy in HBR patients undergoing PCI is essential.
• Careful consideration of bleeding risk is critical for improving prognosis post-PCI.
• Personalized antithrombotic strategies are needed to improve safety and efficacy.