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Percutaneous coronary intervention in patients with active bleeding or high bleeding risk [Anatol J Cardiol]
Anatol J Cardiol. 2013; 13(2): 165-170 | DOI: 10.5152/akd.2013.042  

Percutaneous coronary intervention in patients with active bleeding or high bleeding risk

James Nguyen1, Thach Nguyen2
1University of Arizona Medical Center, Tucson, AZ-USA
2Department of Cardiology, St. Mary Medical Center, Hobart, IN-USA

There is a lack of evidence from randomized clinical trials (RCT) supporting percutaneous coronary intervention (PCI) in patients with high bleeding risk or active bleeding. The management decisions are based on extrapolation of subgroups data in RCTs or expertsí opinions. Bleeding in the peri-PCI period also increases mortality. In general, PCI can be performed if bleeding can be stopped by mechanical means (compressing or ligating the artery) and the patient can tolerate 4 hours of anticoagulant without further bleeding. For patient with acquired or inherited high risk of bleeding, anecdotal reports showed that either unfractionated heparin or bivalirudin would be acceptable for PCI. For patients on chronic oral anticoagulants, PCI could be performed without new antithrombotic therapy if the international ratio (INR) is between 2 and 3. Antiplatelet therapy would be needed if new thrombi are detected at the index artery. Ultimately, the decision to perform PCI or treat the patient conservatively must be managed on a case-by-case basis.†† If the benefits outweigh the risk, then the patient can undergo PCI.†

Keywords: Percutaneous coronary interventions, bleeding, ST-segment elevation myocardial infarction


James Nguyen, Thach Nguyen. Percutaneous coronary intervention in patients with active bleeding or high bleeding risk. Anatol J Cardiol. 2013; 13(2): 165-170


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