Bifurcation Stenting and Antithrombotic Therapy

Dr. Arzu Neslihan Akgün

Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Percutaneous coronary intervention for bifurcation lesions is associated with an increased risk of ischemic events and it is considered a complex percutaneous coronary intervention. There is still no clear consensus on the best approach or ideal antithrombotic treatment to reduce both bleeding and ischemic complication risks. Researchers have studied long-term dual antiplatelet therapy (DAPT) and the use of more potent P2Y12 inhibitors in many cases. Long-term dual antiplatelet therapy (12 months or longer) may reduce the risk of stent thrombosis and myocardial infarction in patients with bifurcation lesions, but it also increases the risk of bleeding. In patients at high risk of bleeding, short-term dual antiplatelet therapy is recommended because long-term therapy does not provide significant ischemic or mortality benefits and significantly increases the risk of bleeding. Treatment decisions should focus on balancing each patient’s bleeding and ischemic risks. Although there are no specific guideline recommendation for bifurcation lesions, studies suggest that for high-risk patients, like those with acute coronary syndrome, ticagrelor monotherapy might be a better option. Potent P2Y12 inhibitors, such as ticagrelor, could be a reasonable option for those at high risk of ischemic events but low risk of bleeding. For patients with atrial fibrillation undergoing percutaneous coronary inter- vention, managing the optimal antithrombotic therapy is even more complex. Non-vitamin K antagonist oral anticoagulant based therapies have been shown to reduce the risk of bleeding compared to warfarin, without increasing the thrombotic risks. Even though most of the recommendations on these therapies come from smal studies or subgroup analyses of larger trials, treatment decisions are often based on the individual’s clinical presentation, their bleeding and ischemic risk factors, and the strategy used during the procedure.

Keywords: Percutaneous coronary intervention; Anticoagulants; Drug therapy; Coronary Thrombosis; Acute coronary syndrome

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