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Antithrombotic therapy in complex percutaneous coronary intervention.

Domenico Simone Castiello1, Angelo Oliva2, Giuseppe Andò3

  • 1Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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Optimizing antithrombotic therapy after complex percutaneous coronary intervention (PCI) is crucial. Tailoring treatment to patient profiles and PCI complexity balances ischemic risk and bleeding risk for better outcomes.

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Percutaneous coronary intervention (PCI) is a primary treatment for advanced coronary artery disease.
  • Antithrombotic therapy is essential for preventing ischemic events post-PCI.
  • Complex PCI presents challenges due to increased bleeding risk.

Purpose of the Study:

  • To review current evidence on antithrombotic management after complex PCI.
  • To guide personalized antithrombotic strategies based on patient and procedure factors.
  • To address optimal treatment in specific complex PCI scenarios.

Main Methods:

  • Systematic review of existing literature on antithrombotic therapy in complex PCI.
  • Analysis of data regarding dual antiplatelet therapy, P2Y12 inhibitor monotherapy, and dual pathway inhibition.
  • Discussion of antithrombotic management in specific patient groups and complex anatomies.

Main Results:

  • No single antithrombotic regimen is suitable for all patients undergoing complex PCI.
  • Risk stratification is key to balancing ischemic and bleeding risks.
  • Specific approaches like prolonged DAPT, P2Y12 monotherapy, and dual pathway inhibition show promise.

Conclusions:

  • Personalized antithrombotic strategies are necessary for complex PCI.
  • Further research is needed to refine optimal antithrombotic regimens.
  • Careful consideration of patient-specific factors and PCI complexity is paramount.