Chayakrit Krittanawong: Precision Anticoagulation in the Cath Lab – What Happens when the Patient Doesn’t Look like the Trial?
Chayakrit Krittanawong, The ACC/AHA Joint Committee on Clinical Data Standards at American College of Cardiology, Founder of HumanX, shared a post on LinkedIn:
“Precision anticoagulation in the cath lab: What happens when the patient doesn’t look like the trial?
Following our review of intraprocedural anticoagulation in the cardiac catheterization laboratory: Part 1, I’m excited to share Part 2, focusing on patients who are often left out of the evidence.
STEMI after fibrinolysis
- Mechanical circulatory support
- Nonagenarians
- Warfarin and DOAC therapy
- Cirrhosis
- Advanced CKD and ESRD
- Thrombocytopenia
The challenge is simple:
The patients at highest risk of bleeding and thrombosis are often the patients with the least randomized evidence.
An elevated INR in cirrhosis doesn’t necessarily mean a patient is ‘auto-anticoagulated’.
A patient on a DOAC may still need intraprocedural anticoagulation.
Impella and ECMO require different anticoagulation strategies.
And in ESRD, nonagenarians, and thrombocytopenia, the usual risk scores may not tell the whole story.
One-size-fits-all anticoagulation doesn’t fit these patients.
The future is precision-guided anticoagulation: patient, procedure, device, and real-time risk.”
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