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Thromb Haemost 2023; 123(02): 135-149
DOI: 10.1055/s-0042-1750419
Theme Issue Article

Resumption of Antiplatelet Therapy after Major Bleeding

Tobias Geisler‡   *
1   Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
,
Sven Poli‡   *
2   Department of Neurology & Stroke, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
3   Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
,
Kurt Huber
4   3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Medical Faculty, Sigmund Freud University, Vienna, Austria
,
Dominik Rath
1   Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
,
Parwez Aidery
1   Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
,
Steen D. Kristensen
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
,
Robert F. Storey
7   Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
,
Alex Ball
8   Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
,
Jean-Philippe Collet 
9   ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Sorbonne Université, Paris, France
,
Jurriën ten Berg
10   Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
11   Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Abstract

Major 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.

Keywords

bleeding - antiplatelet therapy - resumption of antiplatelet therapy - intracranial bleeding - gastrointestinal bleeding - aspirin - dual antiplatelet therapy

* Contributed equally, shared first authorship.




Publikationsverlauf

Eingereicht: 01. März 2022

Angenommen: 26. April 2022

Artikel online veröffentlicht:
04. Juli 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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