ABC | Volume 113, Nº1, July 2019

Statement Statement on Antiplatelet Agents and Anticoagulants in Cardiology – 2019 Arq Bras Cardiol. 2019; 113(1):111-134 Table 1 – CHA 2 DS 2 VASc Criteria Description Points C Congestive heart failure 1 H Hypertension 1 A 2 Age (≥ 75) 2 D Diabetes mellitus 1 S 2 Prior TIA or stroke 2 V Vascular disease (prior AMI, PAD, or aortic plaque) 1 A Age (65-74) 1 Sc Sex (female) 1 AMI: acute myocardial infarction; PAD: peripheral arterial disease; TIA: transient ischemic attack. Table 2 – HAS-BLED Criteria Risk factor Points H Arterial hypertension (SAP > 160 mmHg) 1 A Abnormal kidney function: CrCl ≤ 50 mL/min or creatinine ≥ 2.26 mg/dL or hemodialysis or kidney transplant 1 Abnormal liver function: bilirubin ≥ 2 × ULN or AST/ALT/AP ≥ 3 × ULN or hepatic cirrhosis 1 S Prior stroke 1 B Prior bleeding or predisposition to bleeding 1 L Labile INR or < 60% time within therapeutic range 1 E Age > 65 1 D Drug use (NSAID, antiplatelet) 1 Alcohol use (> 20 U per week) 1 ALT: alanine aminotransferase; AP: alkaline phosphatase; AST: aspartate aminotransferase; CrCl: creatinine clearance; INR: international normalized ratio; NSAID: nonsteroidal anti-inflammatory drugs; SAP: systolic arterial pressure; U: units; ULN: upper limit of normal. For all patients who are receiving oral anticoagulants and who will undergo PCI, it is necessary to proceed to evaluating the need for maintaining anticoagulation and to calculate the risk of bleeding. When AF is the reason for anticoagulation, the CHA 2 DS 2 - VASc score should be utilized, and maintenance should only be indicated when the score is ≥ 1 in men or ≥ 2 in women (Table 1). On the other hand, in patients with thromboembolic events or mechanical valve prostheses, anticoagulation should be maintained, regardless of any assessment. 5-7 Risk of bleeding should be assessed through the HAS-BLED score (Table 2). When it is ≥ 3, the patient is classified as at a high risk of bleeding. This should not contraindicate any form of treatment; however, it must be clear that the individual should be accompanied with more frequent consultations and that it is necessary to attempt to modify the risk factors present in the score in order to reduce the risk. 6-8 2.2. Management of Antithrombotic Agents and the Moment of Percutaneous Coronary Intervention Interrupting oral anticoagulation (OAC) during the periprocedural period can increase both the rate of bleeding and the rate of thromboembolic events. Although there is no consistent evidence, the introduction of parenteral anticoagulants in patients receiving warfarin should only be considered when the international normalized ratio (INR) is less than 2.5. PCI may be performed while using anticoagulants; however, it should be postponed, if possible, until the patient’s INR is < 1.5, unless there is an emergency situation, and it is necessary to take high ischemia risk (GRACE score > 140, TIMI score ≥ 5, recurrent angina, refractory angina, hemodynamic instability, or ventricular arrhythmias) into consideration. 7,8 Furthermore, for patients receiving new oral anticoagulants (NOAC), there is also no evidence as to whether parenteral 114