Optimal management of high bleeding risk patients undergoing percutaneous coronary interventions: Where do we stand?

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Percutaneous coronary interventions (PCI) are standard for obstructive coronary artery disease.
• Managing antiplatelet therapy post-PCI is challenging in high-bleeding-risk patients, particularly those with atrial fibrillation.
• Individualized treatment strategies are crucial for optimizing outcomes and minimizing adverse events.

Purpose of the Study:

• To review recent advancements in PCI procedural planning and pharmacotherapy.
• To discuss novel technologies and hypotheses for managing high-bleeding-risk patients undergoing PCI.
• To provide guidance on managing specific patient phenotypes, such as those with atrial fibrillation and chronic kidney disease.

Main Methods:

• Review of current clinical practices and emerging technologies in interventional cardiology.
• Analysis of strategies for optimizing dual antiplatelet therapy duration and drug-coated balloon utilization.
• Evaluation of imaging-guided PCI techniques for improved stent expansion.

Main Results:

• Novel approaches include shorter dual antiplatelet therapy durations, single antiplatelet regimens, drug-coated balloons, and imaging-guided PCI.
• Tailored management is essential for high-bleeding-risk patients, as 'one size does not fit all'.
• Emerging guidelines address specific comorbidities like atrial fibrillation and chronic kidney disease.

Conclusions:

• Personalized strategies are key to balancing efficacy and safety in PCI for high-bleeding-risk patients.
• Recent technological and pharmacological advancements offer improved management options.
• Expert opinions and algorithms are needed to guide clinical decision-making in complex patient phenotypes.