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Antithrombotic Strategies After Complex Percutaneous Coronary Intervention

Yasushi Ueki1, Koichiro Kuwahara1

  • 1Department of Cardiovascular Medicine, Shinshu University Hospital, Nagano 390-8621, Japan.

Journal of Clinical Medicine
|July 15, 2026
PubMed

Insights

Managing antithrombotic therapy after complex percutaneous coronary intervention (PCI) is crucial. Balancing ischemic and bleeding risks is key for optimal patient outcomes in these challenging revascularization cases.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Pharmacology

Background:

  • Complex percutaneous coronary intervention (PCI) is increasing due to aging populations and comorbidities.
  • Complex PCI involves challenging lesions like left main disease, chronic total occlusions, and severe calcification.
  • Antithrombotic therapy is vital post-PCI but poses a high bleeding risk in these patients.

Purpose of the Study:

  • To review current evidence and guidelines on antithrombotic therapy after complex PCI.
  • To discuss balancing ischemic and bleeding risks in patients undergoing complex PCI.
  • To provide clinical considerations for antithrombotic management post-complex PCI.

Main Methods:

  • Literature review of contemporary evidence.
  • Synthesis of current guideline recommendations.
  • Analysis of clinical considerations for antithrombotic therapy.

Main Results:

  • Complex PCI is a growing area of coronary revascularization.
  • Balancing ischemic and bleeding risks is paramount in antithrombotic selection.
  • Guideline recommendations shift focus from procedural complexity to risk stratification.

Conclusions:

  • Antithrombotic therapy requires careful management after complex PCI.
  • Risk-benefit assessment is essential for tailoring antithrombotic regimens.
  • Contemporary approaches prioritize individualized patient care over solely procedural factors.

Keywords:
anticoagulationantiplatelet therapybleedingpercutaneous coronary intervention

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