Antithrombotic Therapy After PCI in High-Risk Cardiovascular Patients: Navigating Complexity Beyond Guidelines

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Antithrombotic therapy is vital for cardiovascular disease but challenging in real-world patients.
• Elderly, multimorbid, or cancer patients are often underrepresented in clinical trials.
• Guidelines may not fully address complex patient populations with competing risks.

Purpose of the Study:

• To review antithrombotic strategies in high-risk patient groups.
• To address challenges in frail patients, advanced chronic kidney disease, active cancer, and atrial fibrillation post-PCI.
• To propose practical considerations for optimizing antithrombotic therapy.

Main Methods:

• Critical narrative review of current antithrombotic strategies.
• Appraisal of bleeding risk scores' limitations.
• Focus on specific high-risk scenarios and clinical decision-making.

Main Results:

• Standard antithrombotic approaches need modification in specific high-risk populations.
• Existing bleeding risk scores have limitations.
• Tailoring therapy duration, minimizing combinations, and reassessing risk are key.

Conclusions:

• Antithrombotic management requires careful balancing of thrombosis and bleeding risks.
• Personalized strategies are essential for frail patients, those with CKD, cancer, or AF post-PCI.
• Optimizing net clinical benefit necessitates individualized antithrombotic care.