Periprocedural Antithrombotic Treatment in Complex Percutaneous Coronary Intervention

Abstract

:In recent years, the management of complex lesions in patients undergoing percutaneous coronary intervention (PCI) constitutes a field of high interest and concern for the interventional cardiology. As more and more studies demonstrate the increased hazard of ischemic events in this group of patients, it is of paramount importance for the physicians to choose the optimal periprocedural (pre-PCI, during-PCI and post-PCI) antithrombotic treatment strategies wisely. Evidence regarding the safety and efficacy of current anticoagulation recommendation, the possible beneficial role of the pretreatment with a potent P2Y12 inhibitor in the subgroup of patients with non-ST segment elevation myocardial infarction with complex lesions, and the impact of a more potent P2Y12 inhibitor in individuals with stable coronary artery disease undergoing complex PCI are needed. This will provide and serve as a guide to clinicians to deploy the maximum efficacy of the current choices of antithrombotic therapy, which will lead to an optimal balance between safety and efficacy in this demanding clinical scenario.

Efficacy and Safety of Thirty-Day Dual-Antiplatelet Therapy Following Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…Using DAPT for an extended period and/or using a potent P2Y12 inhibitor, such as ticagrelor or prasugrel, may decrease the residual ischemic risk, but it may also lead to an increase in bleeding events [2][3][4]. The risk of ischemic events following percutaneous coronary intervention (PCI) is directly proportional to the complexity of the procedure, owing to both anatomical and technical factors [5][6][7]. Moreover, patient characteristics, like diabetes mellitus, active cancer, or tobacco smoking, could lead to an increased risk for ischemic events [8][9][10].…”