Antithrombotic therapy after cardiac percutaneous interventions is key for the prevention of thrombotic events, but is inevitably associated with increased bleeding, proportional to the number, duration, and potency of the antithrombotic agents used. Bleeding complications have important clinical implications, which in some cases may outweigh the expected benefit of reducing thrombotic events. Because the response to antithrombotic agents varies widely among patients, there has been a relentless effort towards the identification of patients at high bleeding risk (HBR), in whom modulation of antithrombotic therapy may be needed to optimize the balance between safety and efficacy. Among patients undergoing cardiac percutaneous interventions, recent advances in technology have allowed for strategies of de-escalation to reduce bleeding without compromising efficacy, and HBR patients are expected to benefit the most from such approaches. Guidelines do not expand on the topic of de- escalation strategies of antithrombotic therapy in HBR patients. In this review, we discuss the evidence and provide practical recommendations on optimal antithrombotic therapy in HBR patients undergoing various cardiac percutaneous interventions.

Editors

JACC: Cardiovascular Interventions Editor-in-Chief
David J. Moliterno, MD, FACC

JACC: Cardiovascular Interventions CME/MOC Editor
Michael C. McDaniel, MD

Author

Martina Berteotti, MD, PhD

Important Dates

Date of Release: October 14, 2024
Term of Approval/Date of CME/MOC Expiration: October 13, 2025