Anticipating and managing bleeding complications in patients with coronary stents who are receiving dual antiplatelet treatment

#### Summary points Coronary artery stents are used to treat the full spectrum of coronary heart diseases, from stable angina through to ST elevation myocardial infarctions, and stent insertions are common medical procedures, with more than 80 000 and 1.3 million performed in the United Kingdom and United States each year, respectively.1 2 Both bare metal stents and drug eluting stents, which release anti-proliferative drugs and reduce restenosis, are commonly used. Although drug eluting stents have been associated with lower rates of medium term vascular complications, such as revascularisation, there have been concerns about other rarer later vascular outcomes. Of particular concern is the apparent small absolute risk of in-stent thrombosis with drug eluting stents. To prevent these vascular complications, treatment with multiple antithrombotic drugs, including dual antiplatelet treatment (such as aspirin and clopidogrel), is an important part of acute stent management. To reduce the risk of in-stent thrombosis, longer periods of dual antiplatelet treatment are needed for drug eluting stents than for bare metal stents. However, antithrombotic treatments are associated with an increased risk of bleeding, which can …