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Percutaneous coronary intervention in the patient on oral anticoagulation 

Percutaneous coronary intervention in the patient on oral anticoagulation
Chapter:
Percutaneous coronary intervention in the patient on oral anticoagulation
Author(s):

K. E. Juhani Airaksinen

, Andrea Rubboli

, Deepak L. Bhatt

, Eric Eeckhout

, and Gregory Y. H. Lip

DOI:
10.1093/med/9780199665952.003.0004
Page of

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date: 25 November 2020

Owing to the need to balance the risk of thromboembolism, stent thrombosis, major adverse cardiac events, and bleeding, the management of antithrombotic therapy in patients on oral anticoagulation undergoing percutaneous coronary intervention is complex. To minimize the risk of peri-procedural bleeding, extensive use of radial approach, avoidance of glycoprotein IIb/IIIa inhibitors, and uninterrupted oral anticoagulation with vitamin K-antagonists are all advised. Triple therapy of vitamin K-antagonist, aspirin, and clopidogrel is the standard antithrombotic regimen throughout the period vulnerable to stent thrombosis. Because of the increased risk of bleeding, triple therapy of vitamin K-antagonist, aspirin, and clopidogrel should be maintained for as short a time as possible, and managed with special care. Owing to the paucity of data regarding newer, more potent antiplatelet agents, and newer non vitamin K-antagonist direct oral anticoagulants, the role of these agents is currently uncertain.

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