Toward an integrated risk paradigm: personalizing antithrombotic therapy for coronary heart disease with gastrointestinal bleeding

The management of antithrombotic therapy in coronary artery disease has long been constrained by the tension between preventing ischemia and provoking bleeding. Current approaches often treat these risks as competing priorities, leading to reactive and unstable treatment plans. This perspective article argues for a fundamental shift toward a risk-integration paradigm, which re-conceptualizes ischemic and bleeding risks as interconnected components of a unified, dynamic patient profile. By adopting a framework of continuous assessment, mechanism-based therapy, phased management, and shared decision-making, this paradigm offers a systematic and individualized strategy for optimizing long-term clinical outcomes.