Antithrombotic Therapy in High Bleeding Risk, Part II: Noncardiac Percutaneous Interventions.

Over the past decades, there have been great advancements in the antithrombotic management of patients undergoing percutaneous interventions, but most of the available evidence derives from studies conducted in the setting of cardiac interventions. Antithrombotic treatment regimens used in patients undergoing percutaneous cardiac interventions, in particular coronary, are frequently extrapolated to patients undergoing noncardiac interventions. However, the differences in risk profile of the population treated and the types of interventions performed may translate into differences is the safety and efficacy associated with antithrombotic therapy. Noncardiac percutaneous interventions are commonly performed in patients at high bleeding risk, which may indeed impact outcomes, hence underscoring the importance of risk stratification to guide clinical decision-making processes. In this review, we appraise the available evidence on antithrombotic therapy in high-bleeding-risk patients undergoing noncardiac percutaneous interventions. [Display omitted] [Display omitted] • There is a paucity of evidence on the optimal antithrombotic treatment regimen to be used in patients undergoing noncardiac percutaneous interventions. Antithrombotic strategies in this setting often empirically reflect that from patients undergoing percutaneous coronary interventions. Similarly, evidence on the incidence and prognostic impact of bleeding as well as on HBR classifications is scarce compared with the coronary setting. • Patients undergoing noncardiac interventions are often characterized by an increased risk of bleeding. In fact, these procedures are often reserved for patients with prohibitively high surgical and bleeding risks (eg, advanced age, multiple comorbidities). Moreover, there are differences in the thrombogenicity of the devices used and in the safety and efficacy of specific antithrombotic regimens between cardiac and noncardiac interventions. • In this review, we discuss definitions and clinical impact of HBR in patients undergoing noncardiac percutaneous interventions and the implications for antithrombotic treatment regimens in this population. [ABSTRACT FROM AUTHOR]