Roxana Mehran on managing ischaemic benefit vs. bleeding harm in HBR patients – Episode 1 of a 3-part series


Episode 1: High bleeding risk patients. Who are they and why are they important?

Roxana Mehran (New York, USA) – in the first of a special three-part series – talks about how bleeding avoidance strategies are vital because bleeding after percutaneous coronary intervention (PCI) is a “very important predictor of mortality”.

Mehran notes that balancing ischaemic benefit against bleeding harm has been “very much central to how we choose our strategies in treating patients post-PCI.” She also looks at how high bleeding risk (HBR) patients are defined, according to the Bleeding Academic Research Consortium, which she notes is the “question everyone asks.”

She also highlights some of the challenges associated with treating HBR patients. One way to balance the risk vs. benefit is to make sure that during the procedure “you are getting the best possible result with the best possible devices”.

In light of scarce evidence, the “natural reaction”, notes Mehran, is to stop the dual antiplatelet therapies, and for some “unclear reason” she says patients are not started on statins or beta blockers, ultimately “exposing them to ischaemic harm”.

“Bleeding matters”, states Mehran, before concluding that “what is really incredible is that the post-discharge bleeding is as important if not more important than myocardial infarction”.

This video is sponsored by Medtronic.

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