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 language | English (US) |
|---|---|
| Pages (from-to) | 311-318 |
| Number of pages | 8 |
| Journal | Current Opinion in Cardiology |
| Volume | 30 |
| Issue number | 4 |
| DOIs | |
| State | Published - Aug 24 2015 |
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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 journal › Article
}
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 -