Balance of ischemia and bleeding in selecting antithrombotic regimens

In the USA, coronary revascularization by percutaneous coronary intervention (PCI) is performed over 1 million times annually. However, PCI has only been associated with improved clinical outcomes when performed for acute coronary syndromes. In patients with stable coronary artery disease, there is an ongoing debate concerning the clinical usefulness of PCI. This chapter provides an overview of pharmacologic treatment strategies to optimize the safety and efficacy of PCI by minimizing the risk of ischemic and bleeding outcomes. Both ischemic and bleeding complications are associated with an increased risk of mortality after PCI. Antithrombotic therapy in PCI is focused on minimizing thrombotic complications while limiting the number of bleeding events. An aspirin loading dose of 325 mg orally or 500 mg intravenously is administered before PCI. Clopidogrel, prasugrel, and ticagrelor inhibit platelet activation by antagonizing the adenosine diphosphate receptor P2Y12.