Bleeding in Antiplatelet Therapy: A Narrative Review of Clinical Evidence and the Roles of Pharmacists and Nurses.

To accumulate and evaluate current evidence on bleeding complications associated with antiplatelet therapy and the specific contributions of pharmacists and nurses to bleeding-risk mitigation. Antiplatelet agents prevent arterial thrombosis by inhibiting platelet aggregation through blocking cyclooxygenase-1, P2Y12 receptors, glycoprotein (GP) IIb/IIIa receptors, or phosphodiesterase pathways. These mechanisms simultaneously impair primary hemostasis, increasing the risk of intracranial, gastrointestinal, or other clinically significant bleeding. Bleeding risk is dose-, duration-, and drug-dependent; meanwhile, dual antiplatelet therapy (DAPT) and concurrent use of anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or proton pump inhibitors all amplify the risk. Patient-specific factors, likely older ages, anemia, renal or hepatic impairment, prior bleeding, cancer, diabetes, and frailty further increase the hazard. Shortened DAPT or P2Y12 inhibitor monotherapy reduces bleeding without increasing thrombotic events. Pharmacists optimize regimens, screen for interactions, educate patients, and co-develop institutional protocols; nurses monitor early signs of bleeding, ensure adherence, and coordinate multidisciplinary care. Both roles demonstrably decrease the incidence and severity of bleeding. Individualized antiplatelet strategies, guided by refined risk-stratification tools and delivered through pharmacist-nurse integrated care models, can maximize antithrombotic benefit while minimizing bleeding harm. Thus, large prospective trials and cost-effectiveness analyses are warranted to validate these multidisciplinary interventions.