Evaluating The Bite of BARC
Therapeutic options for patients with acute coronary syndrome (ACS) and those undergoing percutaneous coronary intervention (PCI) have evolved significantly over the past decade. In the era when there were limited antithrombotic choices, reduction of ischemic events was the primary goal regardless of the risk of bleeding that was associated with the use of antiplatelet and anticoagulant therapies. In the current era, clinicians are faced with five oral antiplatelet options (aspirin, ticlopidine, clopidogrel, prasugrel, ticagrelor), three intravenous antiplatelet agents (abciximab, eptifibatide, tirofiban), four anticoagulants (unfractionated heparin, low molecular weight heparin, bivalirudin, fondaparinux), and potentially additional oral anticoagulants for long-term secondary prevention1. In general, the iterations in antithrombotic drugs have been directed at achieving greater potency; however, some agents, like fondaparinux and bivalirudin, were developed specifically in the context of maintaining antithrombotic efficacy but with better safety (i.e., lower bleeding risk)2,3.The focus on bleeding risk is a relatively new development, and is likely driven by the robust literature demonstrating an association between bleeding during the management of ACS or in the setting of PCI and subsequent short- and long-term adverse outcomes such as myocardial infarction (MI), stroke, stent thrombosis, and death4,5 (SELECT FULL TEXT TO CONTINUE)
- Received February 14, 2012.
- Accepted February 15, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited