Key result
Recent evidence points to the superiority of dual over triple antithrombotic therapy for bleeding prevention in PCI patients requiring oral anticoagulation, though data in complex PCI remain scarce.
Why the study?
Patients requiring oral anticoagulation undergoing complex PCI are underrepresented in randomized trials, leaving scarce data on the optimal type and duration of antithrombotic therapy balancing ischemic and bleeding risks.
This review highlights the therapeutic dilemma and summarizes current evidence and guideline suggestions for balancing bleeding and ischemic risks in patients on chronic anticoagulation who require complex PCI.
Dual therapy may be preferred to reduce bleeding in anticoagulated PCI patients; confirms overall benefit but leaves complex PCI data gap open.
The optimal antithrombotic treatment in patients receiving oral anticoagulation undergoing percutaneous coronary intervention (PCI) has been a field of intensive research. Although triple antithrombotic therapy had been, until lately, the strategy of choice, recent evidence points to the superiority of dual antithrombotic therapy regarding bleeding prevention, without significantly compromising efficacy. In the further challenging scenario of complex PCI, associated with a higher ischemic risk, the efficacy of an aspirin-free strategy, adopted shortly after the index event is under question, rendering decision-making a fairly difficult scenario for clinicians. Since patients with an indication for oral anticoagulation undergoing complex PCI are underrepresented in randomized trials, there are scarce data regarding the optimal treatment strategy in such patients. This review aims to analyze and compare different approaches regarding the type and duration of antithrombotic regimens, focusing on both safety and efficacy outcomes, as well as to discuss recent guidelines' suggestions regarding the therapeutic approach in patients receiving oral anticoagulation undergoing PCI procedures of increased complexity.
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Benetou et al. (2021) conducted a review in Patients receiving oral anticoagulation undergoing complex percutaneous coronary intervention (PCI). Antithrombotic therapy (dual vs. triple) was evaluated. Recent evidence points to the superiority of dual over triple antithrombotic therapy for bleeding prevention in PCI patients requiring oral anticoagulation, though data in complex PCI remain scarce.
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