Antiplatelet Therapy in High-Bleeding Risk Patients Undergoing PCI: Walking a Tightrope

Overview

Journal Rev Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 30

PMID 39077183

Authors

Davis Jones

Johny Nicolas

Frans Beerkens

Mohan Satish

Daniel Feldman

Davide Cao

Alessando Spirito

Roxana Mehran

Affiliations

Soon will be listed here.

Abstract

Historically, prevention from ischemic events with dual antiplatelet therapy (DAPT) post percutaneous coronary intervention (PCI) took precedence over protection from bleeding. However, increasing data suggest that major bleeding complications are as detrimental as ischemic events. Awareness about the prognostic impact of bleeding prompted the search for new strategies aimed at maximizing both ischemic and bleeding protection. This is noteworthy because patients at high bleeding risk (HBR) have generally been underrepresented in clinical trials on DAPT and they often are at increased risk of ischemic events as well. The present review discusses the evidence base for new pharmacotherapeutic strategies to decrease bleeding risk without compromising ischemic protection among HBR patients undergoing PCI, including shortening DAPT duration, early aspirin withdrawal, and inhibitor de-escalation.

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