Article ; Online: Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk.
2023 Volume 38, Issue 6, Page(s) 515–520
Abstract: Purpose of review: Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI).: Recent findings: Patients with HBR after PCI include those with advanced ...
Abstract | Purpose of review: Review the clinical outcomes of different antithrombotic strategies in patients with high bleeding risk (HBR) after percutaneous coronary intervention (PCI). Recent findings: Patients with HBR after PCI include those with advanced age (e.g. >75 years of age), a prior history of major bleeding, anemia, chronic kidney disease, and those with indications for long-term anticoagulation. Strategies that successfully decrease bleeding risk in this population include shorter durations of dual antiplatelet therapy (DAPT; of 1-3 months) followed by single antiplatelet therapy with aspirin or a P2Y 12 inhibitor, or de-escalating from a more potent P2Y 12 inhibitor (prasugrel or ticagrelor) to less potent antiplatelet regimens (aspirin with clopidogrel or half-dose ticagrelor or half-dose prasugrel). Patients on DAPT, and a full dose anticoagulation for other indications, have a lower risk of major bleeding without an increase in 1-2-year adverse ischemic events, when rapidly switched from DAPT to a single antiplatelet therapy (within a week after PCI) with aspirin or clopidogrel. Longer term data on the benefits and risks of these strategies is lacking. Summary: In patients with HBR after PCI, shorter durations of DAPT (1-3 months) decrease the risk of major bleeding without increasing the risk of adverse ischemic events. |
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MeSH term(s) | Humans ; Platelet Aggregation Inhibitors ; Clopidogrel/therapeutic use ; Clopidogrel/adverse effects ; Ticagrelor/adverse effects ; Prasugrel Hydrochloride/therapeutic use ; Fibrinolytic Agents/adverse effects ; Percutaneous Coronary Intervention/adverse effects ; Hemorrhage/chemically induced ; Hemorrhage/prevention & control ; Aspirin ; Anticoagulants/adverse effects ; Treatment Outcome ; Acute Coronary Syndrome/drug therapy |
Chemical Substances | Platelet Aggregation Inhibitors ; Clopidogrel (A74586SNO7) ; Ticagrelor (GLH0314RVC) ; Prasugrel Hydrochloride (G89JQ59I13) ; Fibrinolytic Agents ; Aspirin (R16CO5Y76E) ; Anticoagulants |
Language | English |
Publishing date | 2023-07-28 |
Publishing country | United States |
Document type | Review ; Journal Article |
ZDB-ID | 645186-x |
ISSN | 1531-7080 ; 0268-4705 |
ISSN (online) | 1531-7080 |
ISSN | 0268-4705 |
DOI | 10.1097/HCO.0000000000001075 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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