Resumption of Antiplatelet Therapy after Major Bleeding

Author:

Geisler Tobias1,Poli Sven23,Huber Kurt4,Rath Dominik1,Aidery Parwez1,Kristensen Steen D.56,Storey Robert F.7,Ball Alex8,Collet Jean-Philippe9ORCID,Berg Jurriën ten1011

Affiliation:

1. Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany

2. Department of Neurology & Stroke, Eberhard-Karls-University Tuebingen, Tuebingen, Germany

3. Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tuebingen, Tuebingen, Germany

4. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Medical Faculty, Sigmund Freud University, Vienna, Austria

5. Department of Cardiology, Aarhus University Hospital, Faculty of Health, Aarhus University, Aarhus, Denmark

6. Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark

7. Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom

8. Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom

9. ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France

10. Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands

11. Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands

Abstract

AbstractMajor bleeding is a common threat in patients requiring antiplatelet therapy. Timing and intensity with regard to resumption of antiplatelet therapy represent a major challenge in clinical practice. Knowledge of the patient's bleeding risk, defining transient/treatable and permanent/untreatable risk factors for bleeding, and weighing these against thrombotic risk are key to successful prevention of major adverse events. Shared decision-making involving various disciplines is essential to determine the optimal strategy. The present article addresses clinically relevant questions focusing on the most life-threatening or frequently occurring bleeding events, such as intracranial hemorrhage and gastrointestinal bleeding, and discusses the evidence for antiplatelet therapy resumption using individual risk assessment in high-risk cardiovascular disease patients.

Publisher

Georg Thieme Verlag KG

Subject

Hematology

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