High bleeding risk patients undergoing percutaneous coronary intervention
- J Dawn Abbott, MD, FACC
J Dawn Abbott, MD, FACC
- Associate Professor of Medicine
- Brown Medical School
- Section Editors
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
- Stephan Windecker, MD
Stephan Windecker, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Department of Cardiology
- Bern University Hospital
Percutaneous coronary intervention (PCI) with placement of an intracoronary stent requires treatment with dual antiplatelet therapy (DAPT) for some period of time, which is as short as one month or as long as up to three years. (See "Long-term antiplatelet therapy after coronary artery stenting in stable patients".)
Such therapy improves outcomes of cardiac mortality and myocardial infarction (MI). Some of the improvement is attributable to a reduction in the incidence of stent thrombosis, a complication often associated with MI and death. However, DAPT is associated with an increased risk of major bleeding. For patients undergoing PCI who are identified as being at high risk of bleeding, the optimal management strategy is not known. This topic will discuss this issue in detail.
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- DEFINITION OF HIGH BLEEDING RISK
- ASSESSING BLEEDING RISK
- INCIDENCE OF BLEEDING AFTER PCI
- PROGNOSIS AFTER BLEEDING
- COMPARING BLEEDING AND ISCHEMIC RISK
- BMS VERSUS DES
- MANAGEMENT OF BLEEDING
- OUR APPROACH
- Choice of stent
- P2Y12 receptor blocker
- - Agent
- - Duration
- Timing of PCI
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS