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September 1, 2026Cardiology ResearchOpen Access

Navigating Ischemic and Bleeding Risks in High Bleeding Risk Patients Undergoing Coronary Intervention

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Key result

Shortened DAPT and polymer-free DES maintain ischemic protection while minimizing bleeding in HBR patients.

Why the study?

In patients at high bleeding risk undergoing PCI, standard antithrombotic regimens may cause major bleeding complications, requiring strategies to balance ischemic protection and bleeding safety.

Population

Patients at high bleeding risk undergoing percutaneous coronary intervention

Design

Review

Authors

KXKe Qiang XuLSLu Huan ShenPXPeng Fei Xia

Discussion

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Overview

Supports tailored antithrombotic strategies in HBR PCI patients; leaves open prospective validation of ultra-short DAPT and novel agents.

Key Points

  • Synthesize evidence and risk-stratification tools to establish an individualized management framework that balances ischemic protection and bleeding safety in high bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI).
  • Systematically evaluated pivotal randomized clinical trials (including LEADERS FREE, ZEUS, SENIOR, MASTER DAPT, ONYX ONE, and TWILIGHT) assessing shortened dual antiplatelet therapy (DAPT), polymer-free drug-eluting stents, and antithrombotic de-escalation.
  • Synthesized contemporary clinical guidelines, 2024–2026 evidence on ultra-short DAPT, gene-guided therapy, and factor XI inhibitors, alongside management for special populations including atrial fibrillation, malignancy, and chronic kidney disease.
  • Shortened DAPT regimens, polymer-free and advanced drug-eluting stents, and tailored antithrombotic de-escalation effectively reduce major bleeding complications without increasing ischemic events in HBR populations.
  • Novel approaches—including ultra-short DAPT stratification, genotype-guided antiplatelet selection, and factor XI inhibitors—provide refined risk-balanced revascularization options across complex clinical subgroups.

Structured PICO

P
Population
A comprehensive review of clinical trials and management strategies for patients at high bleeding risk undergoing percutaneous coronary intervention.
I
Intervention
Optimized vascular access, innovations in stent technology (e.g., polymer-free drug-eluting stents), and tailored antithrombotic therapies (e.g., shortened DAPT duration, de-escalation strategies, gene-guided antiplatelet therapy adjustment, and novel factor XI inhibitors)

This review provides a comprehensive framework for managing high bleeding risk patients undergoing PCI, emphasizing personalized antithrombotic strategies and novel stent technologies to balance ischemic and bleeding risks.

Limitations

  • Historical exclusion of high bleeding risk patients from major PCI clinical trials resulting in a lack of high-quality evidence
  • Inconsistent HBR definition criteria adopted in different clinical trials prior to the ARC-HBR consensus

Cite This Study

Xu et al. (2026) conducted a review in Coronary artery disease in patients at high bleeding risk (HBR). Optimized PCI strategies (shortened DAPT, polymer-free DES, de-escalation) vs. Standard antithrombotic regimens and bare-metal stents was evaluated. Modern percutaneous coronary intervention strategies, including shortened dual antiplatelet therapy and polymer-free drug-eluting stents, provide effective ischemic protection while minimizing bleeding risk in high bleeding risk patients.

synapsesocial.com/papers/6a969b5a535111e2d4ce8d09https://doi.org/10.14740/cr2266
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Reassessing PCI Timing in High Bleeding Risk Patients: Evidence, Strategies, and Outcomes2025 · 2 citations
  2. 2New Antithrombotic Strategies and Coronary Stent Technologies for Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention2021 · 1 citations
  3. 3Percutaneous Coronary Interventions: Bleeding Risk Assessment and Management2026
  4. 4Antithrombotic treatment following percutaneous coronary intervention in patients with high bleeding risk2023 · 2 citations
  5. 5Antiplatelet therapy in high-bleeding risk patients with acute coronary syndrome: pharmacogenomics in the era of precision medicine2026