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Costa F, Garcia-Ruiz V, Licordari R, Fimiani L. The High Bleeding Risk Patient with Coronary Artery Disease. Cardiol Clin 2020; 38:481-490. [PMID: 33036711 DOI: 10.1016/j.ccl.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Out-of-hospital bleeding is a common complication after percutaneous coronary intervention (PCI) due to the concomitant need for dual antiplatelet therapy. A significant proportion of patients undergoing PCI carry specific clinical characteristics posing them at high bleeding risk (HBR), increasing the risk of hemorrhagic complications secondary to antithrombotic therapy. Identifying patients at HBR and adjust antithrombotic therapy accordingly to optimize treatment benefits and risk is a challenge of modern cardiology. Recently, multiple definitions and tools have been provided to help clinicians with prognostic stratification and treatment decision making in this subgroup.
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Affiliation(s)
- Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Via C Valeria 1, Messina 98100, Italy; Interventional Cardiology Unit, Policlinico G. Martino, Via C Valeria 1, Messina 98100, Italy.
| | - Victoria Garcia-Ruiz
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga 29010, Spain
| | - Roberto Licordari
- Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Via C Valeria 1, Messina 98100, Italy
| | - Luigi Fimiani
- Department of Clinical and Experimental Medicine, Policlinico "G. Martino", University of Messina, Via C Valeria 1, Messina 98100, Italy
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Caracciolo A, Mazzone P, Laterra G, Garcia-Ruiz V, Polimeni A, Galasso S, Saporito F, Carerj S, D’Ascenzo F, Marquis-Gravel G, Giustino G, Costa F. Antithrombotic Therapy for Percutaneous Cardiovascular Interventions: From Coronary Artery Disease to Structural Heart Interventions. J Clin Med 2019; 8:E2016. [PMID: 31752292 PMCID: PMC6912795 DOI: 10.3390/jcm8112016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023] Open
Abstract
Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy.
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Affiliation(s)
- Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Paolo Mazzone
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Giulia Laterra
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Victoria Garcia-Ruiz
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Salvatore Galasso
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Francesco Saporito
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy;
| | - Guillaume Marquis-Gravel
- Duke Clinical Research Institute, Durham, NC 27708, USA;
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
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