IMR Press / RCM / Volume 23 / Issue 6 / DOI: 10.31083/j.rcm2306207
Open Access Review
Antiplatelet Therapy in High-Bleeding Risk Patients Undergoing PCI: Walking a Tightrope
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1 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY 10029-6574, US
2 Cardiovascular Department, Humanitas Gavazzeni, 24125 Bergamo, Italy
*Correspondence: roxana.mehran@mountsinai.org (Roxana Mehran)
Academic Editor: Federico Ronco
Rev. Cardiovasc. Med. 2022, 23(6), 207; https://doi.org/10.31083/j.rcm2306207
Submitted: 24 February 2022 | Revised: 20 April 2022 | Accepted: 9 May 2022 | Published: 1 June 2022
(This article belongs to the Special Issue Recent Advances in Percutaneous Coronary Intervention)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
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 P2Y12 inhibitor de-escalation.

Keywords
high bleeding risk
HBR
percutaneous coronary intervention
antiplatelet therapy
antithrombotic therapy
DAPT
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