Coronary interventions in patients with bleeding and bleeding tendency

Corresponding author: Dr. Thach Nguyen, MD, St. Mary Medical Center, 1500 South Lake Park Ave, Hobart IN 46342, USA. E-mail: [email protected] In general, percutaneous coronary intervention (PCI) is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system. The patients who currently bleed may not tolerate any short term anticoagulant effect. The patients who are easy to bleed may have annoying and prolonged bleeds especially at the surgical or vascular access site while on long term antiplatelet drugs such as clopidogrel or aspirin (ASA). These patients in critical situation such as acute myocardial infarction (AMI) or unstable angina may need to undergo PCI, in spite of the fact that the operators have difficulty in predicting the risk of or controlling further bleeding before or during PCI. Any patients whose bleeding cannot be controlled after PCI should not undergo PCI because they will succumb from hemorrhagic shock. These patients are listed in Table 1. There are many options for reperfusion of the infarctrelated artery (IRA) in AMI patients with bleeding. These options differ or complement each other. Their benefits and risks, advantages and disadvantages will be presented and discussed (Table 2).