[Management of antithrombotic therapy in patients with bleeding after percutaneous coronary intervention]

Bleeding is a frequently encountered complication in patients undergoing percutaneous coronary intervention (PCI) treated with a dual antiplatelet therapy regimen with aspirin plus an oral inhibitor of the P2Y12 platelet receptor (clopidogrel, prasugrel, ticagrelor) or with the combination of antiplatelet drugs and an anticoagulant in patients who have a specific indication for chronic anticoagulation therapy such as atrial fibrillation. The management of antithrombotic therapy during post-PCI bleeding is considerably challenging due to the intrinsic difficulty in estimating the balance between the bleeding risk - increased by antiplatelet and/or anticoagulant therapy - and the thrombotic risk associated with the possible discontinuation of these drugs. Currently, there are no data derived from dedicated studies in this setting and therefore the management of antithrombotic therapy in patients who suffer a hemorrhagic complication after PCI is guided by consensus documents that provide suggestions for the different types of bleeding, based on the severity of the latter. In light of the European documents available, this article will discuss the possible management strategies of antithrombotic therapy (antiplatelet and/or anticoagulant) in the different types of bleeding that can occur in patients undergoing PCI.