Antithrombotic Drug Therapy After Percutaneous Coronary Interventions

Dear Colleagues,

The current management of acute coronary syndrome is increasingly challenging due to the treatment of more complex patients with evermore complex coronary lesions and comorbidities. International guidelines recommend the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 receptor inhibitors clopidogrel, prasugrel, or ticagrelor after percutaneous coronary intervention (PCI). DAPT is the mainstay treatment following PCI with drug-eluting stents (DESs) to prevent thrombotic events, particularly those that may occur at the site of the target lesion. The main fear of cardiologists early after PCI, especially in more complex scenarios, is the risk of stent thrombosis. With the introduction of newer highly biocompatible DESs and the employment of intravascular imaging guidance and stenting optimization techniques, bleeding complications and risks during DAPT have emerged. These bleeding risks are valuable for determining when we should administrate anticoagulant therapy for patients with atrial fibrillation. Otherwise, after complex revascularization, thrombotic risks need a fine balance regarding the choice of potent antiplatelet and its duration, alongside anticoagulant therapy, if necessary. Life-threatening or major bleeding events are detrimental to patient outcomes, underscoring the crucial interplay between ischemic and hemorrhagic risks in determining the net effect of DAPT. Recently, a balance between the pursuit of more potent antithrombotic protection and a more favorable safety profile has been reached. In response, novel strategies have emerged that aim to optimize this equilibrium. These approaches involve modulating the duration and composition of dual antiplatelet therapy (DAPT), tailoring the subsequent monotherapy (aspirin or a potent P2Y12 inhibitor), and exploring dual pathway inhibition with combined antiplatelet and low-dose oral anticoagulation. By carefully considering the individual patient’s risk profile, clinicians can navigate these therapeutic options to provide personalized, evidence-based care and minimize the potential for adverse events.

This Special Issue delves into the latest recommendations and tools for optimizing antithrombotic therapy post-PCI, emphasizing tailored approaches to effectively manage thrombotic and bleeding risks, ultimately enhancing patient outcomes and care quality.

Prof. Dr. Maurizio Del Pinto
Guest Editor

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• thrombotic risk
• bleeding risk
• platelet resistance
• dual antiplatelet therapy
• intracoronary imaging