Incidence and management of complications of fibrinolytic, antiplatelet, and anticoagulant therapy

The treatment of acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) encompasses a wide spectrum of pharmacological strategies ranging from clot lysis in ST segment elevation myocardial infarctions to inhibitors of the coagulation cascade and of platelet aggregation in non-ST segment elevation ACS and PCI. Several combinations of these therapies have been studied in large-scale clinical trials with variable degrees of success in improving clinical outcomes, but occasionally showing unacceptably increased rates of hemorrhage, particularly intracranial hemorrhage (1-3). The risk of major hemorrhage may influence the choice of specific fibrinolytic, antithrombotic, and antiplatelet regimens in specific patient subgroups. For each individual patient, the likelihood of intracranial hemorrhage (4,5) and overall mortality (6) can now be predicted, helping in clinical decision making (7). With the ever-growing armamentarium of potent therapies targeted against thrombosis and platelet activation, risk-benefit assessment becomes pivotal in clinical thrombocardiology.

Duke Scholars

Author Christopher Bull Granger Medicine, Cardiology