Antithrombotic therapy after cardiac percutaneous interventions is key for the prevention of thrombotic events but is inevitably associated with increased bleeding, proportional to the number, duration, and potency of the antithrombotic agents used. Bleeding complications have important clinical implications, which in some cases may outweigh the expected benefit of reducing thrombotic events. Because the response to antithrombotic agents varies widely among patients, there has been a relentless effort toward the identification of patients at high bleeding risk (HBR), in whom modulation of antithrombotic therapy may be needed to optimize the balance between safety and efficacy. Among patients undergoing cardiac percutaneous interventions, recent advances in technology have allowed for strategies of de-escalation to reduce bleeding without compromising efficacy, and HBR patients are expected to benefit the most from such approaches. Guidelines do not extensively expand upon the topic of de-escalation strategies of antithrombotic therapy in HBR patients. In this review, we discuss the evidence and provide practical recommendations on optimal antithrombotic therapy in HBR patients undergoing various cardiac percutaneous interventions.

中文翻译：

---

高出血风险的抗血栓治疗，第一部分：经皮心脏介入治疗


心脏经皮介入治疗后的抗血栓治疗是预防血栓形成事件的关键，但不可避免地与出血增加有关，这与所用抗血栓药物的数量、持续时间和效力成正比。出血并发症具有重要的临床意义，在某些情况下，这可能超过减少血栓形成事件的预期益处。由于患者对抗血栓药物的反应差异很大，因此一直在不懈努力地识别出血风险 （HBR） 高的患者，在这些患者中，可能需要调节抗血栓治疗以优化安全性和有效性之间的平衡。在接受心脏经皮介入治疗的患者中，最近的技术进步允许降阶梯策略在不影响疗效的情况下减少出血，预计 HBR 患者将从此类方法中受益最大。指南并未广泛扩展 HBR 患者抗血栓治疗的降级策略主题。在本综述中，我们讨论了证据，并就接受各种心脏经皮介入治疗的 HBR 患者的最佳抗血栓治疗提供了实用建议。