Precision Medicine for Anticoagulation Strategies in the Cath Lab: Part 2

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Intraprocedural anticoagulation during percutaneous coronary intervention (PCI) presents unique challenges in high-risk and underrepresented patient groups.
• Balancing thrombotic and bleeding risks is complex and often unpredictable in these populations.

Purpose of the Study:

• To review current evidence and identify knowledge gaps in anticoagulant selection, dosing, and monitoring for specific high-risk populations undergoing PCI.
• To address challenges in patients with advanced chronic kidney disease (CKD), cirrhosis, nonagenarians, thrombocytopenia, chronic oral anticoagulation, mechanical circulatory support, and STEMI post-fibrinolysis.

Main Methods:

• Review of contemporary evidence and existing literature on anticoagulation strategies in specialized patient cohorts.
• Analysis of challenges related to altered pharmacokinetics, rebalanced hemostasis, and device-specific risks.

Main Results:

• High-risk populations are often excluded from clinical trials, limiting evidence for optimal anticoagulation.
• Conventional bleeding risk scores have reduced predictive performance in these groups.
• Emerging strategies focus on precision-guided anticoagulation using patient-specific factors, pharmacogenomics, and real-time monitoring.

Conclusions:

• Optimal anticoagulation strategies for high-risk populations undergoing PCI require further investigation through dedicated prospective studies.
• Individualized, precision-guided approaches integrating patient-specific data and advanced monitoring are crucial for improving outcomes.
• There is a need for enhanced risk stratification tools and clinical decision support systems for these complex cases.