Antithrombotic Therapy in High Bleeding Risk, Part II: Noncardiac Percutaneous Interventions

JACC Cardiovasc Interv. 2024 Oct 28;17(20):2325-2336. doi: 10.1016/j.jcin.2024.09.011.

Abstract

Over the past decades, there have been great advancements in the antithrombotic management of patients undergoing percutaneous interventions, but most of the available evidence derives from studies conducted in the setting of cardiac interventions. Antithrombotic treatment regimens used in patients undergoing percutaneous cardiac interventions, in particular coronary, are frequently extrapolated to patients undergoing noncardiac interventions. However, the differences in risk profile of the population treated and the types of interventions performed may translate into differences is the safety and efficacy associated with antithrombotic therapy. Noncardiac percutaneous interventions are commonly performed in patients at high bleeding risk, which may indeed impact outcomes, hence underscoring the importance of risk stratification to guide clinical decision-making processes. In this review, we appraise the available evidence on antithrombotic therapy in high-bleeding-risk patients undergoing noncardiac percutaneous interventions.

Keywords: anticoagulant; antiplatelet; antithrombotic therapy; bleeding; high bleeding risk; percutaneous interventions.

Publication types

  • Review

MeSH terms

  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Clinical Decision-Making
  • Endovascular Procedures / adverse effects
  • Fibrinolytic Agents* / administration & dosage
  • Fibrinolytic Agents* / adverse effects
  • Hemorrhage* / chemically induced
  • Humans
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Thrombosis / etiology
  • Thrombosis / prevention & control
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Anticoagulants