title: Anticoagulation for percutaneous coronary intervention: a contemporary review.
abstract: OBJECTIVE
  Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI.
  
  
  RESULTS
  It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI.
  
  
  CONCLUSIONS
  Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access.
authors.affiliation: aCardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine bElaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miami, Florida, USA.
authors.forename: Abdulla A
authors.initials: AA
authors.lastname: Damluji
authors.forename: Lynda
authors.initials: L
authors.lastname: Otalvaro
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000601:surgery*; D006801:Humans; D062645:Percutaneous Coronary Intervention; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants