Sorrentino Sabato, Salerno Nadia, Leo Isabella, Polimeni Alberto, Sabatino Jolanda, Spaccarotella Carmen Anna Maria, Mongiardo Annalisa, De Rosa Salvatore, Indolfi Ciro
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy | Research Center for Cardiovascular Diseases, Viale Europa, Magna Graecia University, Catanzaro, Italy.
Curr Vasc Pharmacol. 2022;20(1):37-45. doi: 10.2174/1570161119666210809163404.
Patients at High Bleeding Risk (HBR) are a sizable part of the population undergoing Percutaneous Coronary Intervention (PCI) and stent implantation. This population historically lacks standardized definition, thus limiting trial design, data generalizability, and clinical decision-- making. To overcome this limitation, the Academic Research Consortium (ARC) has recently released comprehensive guidelines defining HBR criteria for study design purposes and daily clinical practices. Furthermore, several risk scores have been developed aiming to discriminate against HBR patients and support physicians for clinical decision-making when faced with this complex subset of patients. Accordingly, the first part of this review article will explore guideline-recommended risk scoring as well as ARC-HBR criteria and their relative application for daily clinical practice. The second part of this review article will explore the complex interplay between the risk of bleeding and coronary thrombotic events in patients deemed at HBR. Indeed, several features that identify these patients are also independent predictors of recurrent ischemic events, thus challenging revascularization strategies and optimal antithrombotic therapy. Accordingly, several clinical trials have been conducted to evaluate the safety and efficacy of the new generation of coronary platforms and different antithrombotic strategies for HBR patients to minimize both ischemic and bleeding events. Accordingly, in this part, we discuss current guidelines, trials, and observational data evaluating antithrombotic strategies and stent technologies for patients at HBR.
高出血风险（HBR）患者是接受经皮冠状动脉介入治疗（PCI）和支架植入的相当一部分人群。历史上，这一人群缺乏标准化定义，从而限制了试验设计、数据的可推广性以及临床决策。为克服这一限制，学术研究联盟（ARC）最近发布了全面指南，为研究设计目的和日常临床实践定义了HBR标准。此外，还开发了几种风险评分，旨在识别HBR患者，并在面对这一复杂患者亚群时为医生的临床决策提供支持。因此，本文的第一部分将探讨指南推荐的风险评分以及ARC-HBR标准及其在日常临床实践中的相对应用。本文的第二部分将探讨被认定为HBR的患者出血风险与冠状动脉血栓形成事件之间的复杂相互作用。事实上，识别这些患者的几个特征也是复发性缺血事件的独立预测因素，从而对血运重建策略和最佳抗栓治疗提出了挑战。因此，已经进行了几项临床试验，以评估新一代冠状动脉平台和不同抗栓策略对HBR患者的安全性和有效性，以尽量减少缺血和出血事件。因此，在这一部分中，我们讨论了评估HBR患者抗栓策略和支架技术的当前指南、试验和观察数据。
