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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention: How to Choose the Optimal Antithrombotic Therapy, Its Duration and the Right Stent; A Comprehensive Review of the Current Literature and Proposed Treatment Algorithms

  • Charalampos Kakderis1
  • Matthaios Didagelos1
  • Thomas Zegkos1
  • Konstantinos C. Theodoropoulos1
  • Antonios Kouparanis1
  • Georgios Samprokatsidis1
  • Eleftheria Baltagianni1
  • Stylianos Daios1
  • Athinodoros Nikitopoulos1
  • Thomas Gossios1
  • Vasileios Kamperidis1
  • George Kassimis2
2 more authors
  • Stergios Tzikas3
  • Antonios Ziakas1
  1. 11st Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
  2. 22nd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
  3. 33rd Cardiology Department, Hippokration University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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Abstract

High bleeding risk (HBR) patients represent a significant proportion of those who undergo percutaneous coronary interventions (PCI). The accurate diagnosis of the HBR population is essential because they suffer significantly higher rates of mortality and bleeding compared with non-HBR patients. Although many bleeding risk scores have been developed, the Academic Research Consortium for HBR (ARC–HBR) criteria have established their superiority over the others. In HBR patients without an indication for oral anticoagulant (OAC), shortening the duration of dual antiplatelet therapy (DAPT) is an effective way to minimize bleeding complications in HBR patients with chronic coronary syndromes (CCS). In cases of an acute coronary syndrome (ACS) however, HBR patients combine increased thrombotic burden with an augmented risk of bleeding. Early antiplatelet interruption could result in stent thrombosis with catastrophic consequences. Therefore, in HBR patients with an ACS choosing the optimal DAPT duration, the right P2Y12 inhibitor and the correct time for de-escalation from a potent P2Y12 inhibitor to clopidogrel are of paramount importance. Similar considerations apply to patients with an OAC indication who, according to the ARC–HBR criteria, are HBR. Although new-generation drug-eluting stents (DES) have been developed to induce faster stent endothelization, only few DES have been examined in a HBR population, and these stents should be preferred. The aim of this review is to present the current knowledge of the HBR population and provide comprehensive algorithms to optimally treat HBR patients who undergo PCI with or without an OAC indication and for both ACS and CCS.

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Cite

BibTeXRIS
BibTeX
@article{kakderis2026high,
  title = {{High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention: How to Choose the Optimal Antithrombotic Therapy, Its Duration and the Right Stent; A Comprehensive Review of the Current Literature and Proposed Treatment Algorithms}},
  author = {Charalampos Kakderis and Matthaios Didagelos and Thomas Zegkos and Konstantinos C. Theodoropoulos and Antonios Kouparanis and Georgios Samprokatsidis and Eleftheria Baltagianni and Stylianos Daios and Athinodoros Nikitopoulos and Thomas Gossios and Vasileios Kamperidis and George Kassimis and Stergios Tzikas and Antonios Ziakas},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208035},
  url = {https://www.mdpi.com/2077-0383/15/20/8035},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - High Bleeding Risk Patients Undergoing Percutaneous Coronary Intervention: How to Choose the Optimal Antithrombotic Therapy, Its Duration and the Right Stent; A Comprehensive Review of the Current Literature and Proposed Treatment Algorithms
AU  - Charalampos Kakderis
AU  - Matthaios Didagelos
AU  - Thomas Zegkos
AU  - Konstantinos C. Theodoropoulos
AU  - Antonios Kouparanis
AU  - Georgios Samprokatsidis
AU  - Eleftheria Baltagianni
AU  - Stylianos Daios
AU  - Athinodoros Nikitopoulos
AU  - Thomas Gossios
AU  - Vasileios Kamperidis
AU  - George Kassimis
AU  - Stergios Tzikas
AU  - Antonios Ziakas
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208035
UR  - https://www.mdpi.com/2077-0383/15/20/8035
AB  - High bleeding risk (HBR) patients represent a significant proportion of those who undergo percutaneous coronary interventions (PCI). The accurate diagnosis of the HBR population is essential because they suffer significantly higher rates of mortality and bleeding compared with non-HBR patients. Although many bleeding risk scores have been developed, the Academic Research Consortium for HBR (ARC–HBR) criteria have established their superiority over the others. In HBR patients without an indication for oral anticoagulant (OAC), shortening the duration of dual antiplatelet therapy (DAPT) is an effective way to minimize bleeding complications in HBR patients with chronic coronary syndromes (CCS). In cases of an acute coronary syndrome (ACS) however, HBR patients combine increased thrombotic burden with an augmented risk of bleeding. Early antiplatelet interruption could result in stent thrombosis with catastrophic consequences. Therefore, in HBR patients with an ACS choosing the optimal DAPT duration, the right P2Y12 inhibitor and the correct time for de-escalation from a potent P2Y12 inhibitor to clopidogrel are of paramount importance. Similar considerations apply to patients with an OAC indication who, according to the ARC–HBR criteria, are HBR. Although new-generation drug-eluting stents (DES) have been developed to induce faster stent endothelization, only few DES have been examined in a HBR population, and these stents should be preferred. The aim of this review is to present the current knowledge of the HBR population and provide comprehensive algorithms to optimally treat HBR patients who undergo PCI with or without an OAC indication and for both ACS and CCS.
SN  - 2077-0383
ER  -