Optimization of Antithrombotic Therapy in Patients Undergoing Percutaneous Coronary Intervention

Background
: The optimal management of antiplatelet therapy, both in the periprocedural and chronic phases, in patients undergoing percutaneous coronary intervention (PCI) remains a matter of ongoing debate. Balancing ischemic protection against bleeding risk is central to contemporary treatment strategies, particularly in the era of potent P2Y12 inhibitors and modern drug-eluting stents. Objectives: 
To comprehensively evaluate and compare different antiplatelet strategies in both acute (periprocedural) and chronic settings following PCI. Methods
: A systematic review and meta-analysis of randomized controlled trials was performed to assess different durations of dual antiplatelet therapy (DAPT) and subsequent monotherapy strategies. In parallel, a multicenter registry study was conducted to investigate the real-world use of cangrelor, an intravenous P2Y12 inhibitor, in the periprocedural setting and to characterize bleeding risk of patients receiving cangrelor in contemporary practice. Results: 
Comparative analyses of DAPT duration consistently demonstrated that abbreviated regimens are associated with a more favorable safety profile, with no significant trade-off in ischemic protection compared with the conventional 12-month strategy. These findings were consistent across clinical presentations and treatment strategies, supporting the feasibility of shorter DAPT durations in a broad PCI population.
In the periprocedural setting, real-world data on cangrelor use provided a detailed characterization of patients at increased bleeding risk, identifying key clinical predictors and enabling the development of a dedicated bleeding risk score. This approach allows for improved patient selection and risk stratification in the acute phase of PCI. Conclusions
: Contemporary evidence supports a paradigm shift toward more individualized antiplatelet strategies after PCI. Shortened DAPT durations appear safe and effective for most patients, while tailored approaches in the acute phase—supported by real-world data—may further optimize the balance between ischemic and bleeding risks. Precision-based antiplatelet therapy represents a key step toward improving clinical outcomes in modern interventional cardiology.