Antiplatelet Therapy in High-Bleeding Risk Patients Undergoing PCI: Walking a Tightrope

Davis Jones, Johny Nicolas, Frans Beerkens, Mohan Satish, Daniel Feldman, Davide Cao, Alessando Spirito, Roxana Mehran

Research output: Contribution to journalReview articlepeer-review


Historically, prevention from ischemic events with dual antiplatelet therapy (DAPT) post percutaneous coronary intervention (PCI) took precedence over protection from bleeding. However, increasing data suggest that major bleeding complications are as detrimental as ischemic events. Awareness about the prognostic impact of bleeding prompted the search for new strategies aimed at maximizing both ischemic and bleeding protection. This is noteworthy because patients at high bleeding risk (HBR) have generally been underrepresented in clinical trials on DAPT and they often are at increased risk of ischemic events as well. The present review discusses the evidence base for new pharmacotherapeutic strategies to decrease bleeding risk without compromising ischemic protection among HBR patients undergoing PCI, including shortening DAPT duration, early aspirin withdrawal, and P2Y12 inhibitor de-escalation.

Original languageEnglish
JournalReviews in Cardiovascular Medicine
Issue number6
StatePublished - 2022


  • DAPT
  • HBR
  • antiplatelet therapy
  • antithrombotic therapy
  • high bleeding risk
  • percutaneous coronary intervention


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