title: Percutaneous coronary intervention in patients with active bleeding or high bleeding risk.
abstract: 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 experts' 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.
authors.affiliation: University of Arizona Medical Center, Tucson, AZ-USA. thachnguyen2000@yahoo.com
authors.forename: James
authors.initials: J
authors.lastname: Nguyen
authors.forename: Thach
authors.initials: T
authors.lastname: Nguyen
mesh_terms: D000925:Anticoagulants; D003663:Decision Trees; D006470:Hemorrhage / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D000925:Anticoagulants