Anticoagulation in percutaneous coronary intervention

Balancing safety and efficacy of anticoagulation strategies is a fundamental goal in the performance of percutaneous coronary interventions. The ideal anticoagulant in the catheterization laboratory should effectively prevent thrombosis, yield a low bleeding risk, be titratable to individual clinical needs, be reversible when clinically indicated and be administered without the need for complicated infusions or routine monitoring. Despite its many drawbacks, unfractionated heparin continues to be the most commonly used anticoagulant in percutaneous coronary intervention. Nevertheless, anticoagulation options in the catheterization laboratory have grown substantially over the past 20 years and now include direct thrombin inhibitors, low-molecular-weight heparin molecules and Factor X inhibitors. Additional options are anticipated in the near future with novel agents targeting upstream factors in the coagulation cascade. The availability of multiple anticoagulation options allows for a tailored approach based on the individual patients risk of thrombosis and bleeding. However, multiple anticoagulant choices add complexity in the catheterization laboratory because anticoagulants differ in the mode of administration, monitoring and duration of action. We present a review of current anticoagulation options, novel agents in development and practical issues such as monitoring, switching agents and importance of site access choice.