Anticoagulation for percutaneous coronary intervention: A contemporary review

Abdulla A. Damluji, Lynda Otalvaro, Mauricio G Cohen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose of review Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI. Recent findings It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI. Summary Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access.

Original languageEnglish (US)
Pages (from-to)311-318
Number of pages8
JournalCurrent Opinion in Cardiology
Volume30
Issue number4
DOIs
StatePublished - Aug 24 2015

Fingerprint

Percutaneous Coronary Intervention
Anticoagulants
Hemorrhage
Catheterization
Stents
Blood Vessels
Heparin
Glycoproteins
Thrombosis
Ischemia
Clinical Trials
Safety

Keywords

  • Anticoagulant
  • Coronary artery disease
  • Percutaneous coronary intervention
  • Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Anticoagulation for percutaneous coronary intervention : A contemporary review. / Damluji, Abdulla A.; Otalvaro, Lynda; Cohen, Mauricio G.

In: Current Opinion in Cardiology, Vol. 30, No. 4, 24.08.2015, p. 311-318.

Research output: Contribution to journalArticle

@article{97abbe7a74bd433ab9901307c8b108bb,
title = "Anticoagulation for percutaneous coronary intervention: A contemporary review",
abstract = "Purpose of review Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI. Recent findings It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI. Summary Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access.",
keywords = "Anticoagulant, Coronary artery disease, Percutaneous coronary intervention, Thrombosis",
author = "Damluji, {Abdulla A.} and Lynda Otalvaro and Cohen, {Mauricio G}",
year = "2015",
month = "8",
day = "24",
doi = "10.1097/HCO.0000000000000182",
language = "English (US)",
volume = "30",
pages = "311--318",
journal = "Current Opinion in Cardiology",
issn = "0268-4705",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Anticoagulation for percutaneous coronary intervention

T2 - A contemporary review

AU - Damluji, Abdulla A.

AU - Otalvaro, Lynda

AU - Cohen, Mauricio G

PY - 2015/8/24

Y1 - 2015/8/24

N2 - Purpose of review Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI. Recent findings It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI. Summary Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access.

AB - Purpose of review Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI. Recent findings It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI. Summary Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access.

KW - Anticoagulant

KW - Coronary artery disease

KW - Percutaneous coronary intervention

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=84942592194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942592194&partnerID=8YFLogxK

U2 - 10.1097/HCO.0000000000000182

DO - 10.1097/HCO.0000000000000182

M3 - Article

C2 - 26049375

AN - SCOPUS:84942592194

VL - 30

SP - 311

EP - 318

JO - Current Opinion in Cardiology

JF - Current Opinion in Cardiology

SN - 0268-4705

IS - 4

ER -