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Adjunctive pharmacotherapy for coronary interventions—time to read the writing on the wall

With the new era of coronary stenting supported by triple anti‐platelet therapy, in‐hospital life threatening ischemic complications are rare, and minimally affected by the intensity and duration of the anti‐coagulation protocol. Bleeding complications, however, became the most commonly observed adversity of percutaneous coronary intervention. Hemorrhagic complications are clearly related to the intensity and duration of anti‐coagulation and platelet inhibition protocols, and result in excessive mortality, morbidity, and medical costs. Demographic and clinical predictors of bleeding complications are reviewed. Accumulating data on the safety of PCI with low‐dose unfractionated heparin is pointed out. In view of the contemporary data, the authors question the recently published European and American guideline, which suggest uniform dosing and therapeutic targets for both anticoagulants and glycoprotein IIb/IIIa blockers. Instead, we suggest that these agents will be used judiciously and cautiously tailored, bearing in mind their benefits against the potential to harm. After over three decades of PCI, it is time to engage in dose and duration optimizing studies for these agents.