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Antiplatelet Therapy in High-Bleeding Risk Patients Undergoing PCI: Walking a Tightrope

Davis Jones1, Johny Nicolas1, Frans Beerkens1

  • 1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY 10029-6574, US.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed

Insights

Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) now balances ischemic and bleeding risks. New strategies aim to reduce bleeding in high-risk patients without worsening ischemic events.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) post percutaneous coronary intervention (PCI) historically prioritized preventing ischemic events over bleeding.
  • Emerging evidence indicates major bleeding complications carry risks comparable to ischemic events.
  • Patients at high bleeding risk (HBR) are often underrepresented in DAPT trials and face elevated ischemic event risk.

Purpose of the Study:

  • To review pharmacotherapeutic strategies for reducing bleeding risk in HBR patients undergoing PCI.
  • To evaluate methods that minimize bleeding without compromising ischemic protection.

Main Methods:

  • Review of current evidence on novel pharmacotherapeutic strategies.
  • Analysis of approaches including shortened DAPT duration, early aspirin withdrawal, and P2Y12 inhibitor de-escalation.

Main Results:

  • Discusses strategies to mitigate bleeding risk in HBR patients post-PCI.
  • Highlights the importance of balancing antithrombotic and antihemorrhagic effects.

Conclusions:

  • New strategies are crucial for optimizing outcomes in HBR patients undergoing PCI.
  • Reducing bleeding risk is essential for improving overall prognosis in this population.

Keywords:
DAPTHBRantiplatelet therapyantithrombotic therapyhigh bleeding riskpercutaneous coronary intervention

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