Academic Editor: Federico Ronco
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 P2Y