CLINICAL TRIALS: Edited by Neal S. KleimanAnticoagulation for percutaneous coronary intervention a contemporary reviewDamluji, Abdulla A.a,b; Otalvaro, Lyndaa,b; Cohen, Mauricio G.a,bAuthor Information aCardiovascular Division, Department of Medicine, University of Miami, Miller School of Medicine bElaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miami, Florida, USA Correspondence to Mauricio G. Cohen, MD, FACC, University of Miami Hospital, 1400 N.W. 12th Avenue, Suite 1179, Miami, FL 33136, USA. Tel: +1 305 243 5050; fax: +1 305 243 5578; e-mail: [email protected] Current Opinion in Cardiology: July 2015 - Volume 30 - Issue 4 - p 311-318 doi: 10.1097/HCO.0000000000000182 Buy Metrics Abstract Purpose of review Optimal anticoagulation is needed to prevent ischemic complications during percutaneous coronary interventions (PCIs). The efficacy and safety of new anticoagulants to support PCI in different clinical scenarios have been evaluated in large clinical trials. This review summarizes the major issues and current practices for anticoagulation during PCI. Recent findings It is known that thrombotic events during PCI correlate with poor prognosis. However, the prognostic impact of bleeding is similar or even worse compared with ischemic complications. Therefore, the use of more predictable anticoagulants and safe practices in the catheterization laboratory to balance ischemia and bleeding is an important goal. Mindful of this notion, new anticoagulants with a safer profile, such as bivalirudin, have become popular to avoid bleeding. However, this paradigm shift has resulted in increased rates of acute stent thrombosis after primary PCI. Summary Individual factors associated with increased bleeding risk should be considered in the choice of anticoagulants during PCI. It is now known that the higher bleeding risk observed with heparin-based regimens can be attributed to excessive doses or concomitant use of glycoprotein IIbIIIa inhibitors. In addition to the right anticoagulant choice, operators can avoid bleeding by implementing transradial access and ultrasound-guided and fluoroscopic-guided vascular access. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.