Bleeding avoidance strategies in percutaneous coronary intervention

• Published in: Nature reviews cardiology Vol. 19; no. 2; pp. 117 - 132
• Main Authors: Capodanno, Davide, Bhatt, Deepak L., Gibson, C. Michael, James, Stefan, Kimura, Takeshi, Mehran, Roxana, Rao, Sunil V., Steg, Philippe Gabriel, Urban, Philip, Valgimigli, Marco, Windecker, Stephan, Angiolillo, Dominick J.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2022; Nature Publishing Group
• Subjects: 692/699/75/2/1674; 692/700/565/1436; 692/700/565/2776; Acute coronary syndromes; Angioplasty; Anticoagulants; Cardiac Imaging; Cardiac Surgery; Cardiology; Cardiovascular disease; Coronary vessels; Drug development; Heart attacks; Hemorrhage - chemically induced; Hemorrhage - prevention & control; Humans; Intervention; Ischemia; Medical imaging; Medicine; Medicine & Public Health; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - adverse effects; Review Article; Stents; Thrombosis; Treatment Outcome; Vein & artery diseases
• ISSN: 1759-5002; 1759-5010; 1759-5010
• DOI: 10.1038/s41569-021-00598-1

For many years, bleeding has been perceived as an unavoidable consequence of strategies aimed at reducing thrombotic complications in patients undergoing percutaneous coronary intervention (PCI). However, the paradigm has now shifted towards bleeding being recognized as a prognostically unfavourable event to the same extent as having a new or recurrent ischaemic or thrombotic complication. As such, in parallel with progress in device and drug development for PCI, there is clinical interest in developing strategies that maximize not only the efficacy but also the safety (for example, by minimizing bleeding) of any antithrombotic treatment or procedural aspect before, during or after PCI. In this Review, we discuss contemporary data and aspects of bleeding avoidance strategies in PCI, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens. In this Review, Angiolillo and colleagues discuss the latest evidence and updates on bleeding avoidance strategies in patients undergoing percutaneous coronary intervention, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens. Key points For years, concerns about thrombosis and recurrent ischaemia in patients undergoing percutaneous coronary intervention (PCI) have prevailed, prompting the use of potent antithrombotic strategies and long durations of dual antiplatelet therapy. Remarkable improvements in the way in which PCI is performed have led to a new interest in investigating strategies that target bleeding, especially in patients at higher risk of bleeding. Patients at high risk of bleeding should be promptly identified to define appropriate bleeding prevention strategies. Bleeding avoidance strategies include actions targeted at minimizing the risk of bleeding before, during and after PCI.