Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention.
Aged
Anticoagulants
/ adverse effects
Drug Therapy, Combination
Female
Hemorrhage
/ chemically induced
Humans
Male
Middle Aged
Myocardial Infarction
/ chemically induced
Percutaneous Coronary Intervention
/ adverse effects
Platelet Aggregation Inhibitors
/ adverse effects
Proportional Hazards Models
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Antiplatelet therapy
Bleeding risk score
Oral anticoagulant
Percutaneous coronary intervention
Journal
Journal of cardiology
ISSN: 1876-4738
Titre abrégé: J Cardiol
Pays: Netherlands
ID NLM: 8804703
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
12
09
2018
revised:
29
09
2018
accepted:
17
10
2018
pubmed:
2
1
2019
medline:
26
5
2020
entrez:
2
1
2019
Statut:
ppublish
Résumé
No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents. We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria. TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class ≥3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15-2.64; p=0.01; HR, 1.63; 95% CI, 1.08-2.48; p=0.02; HR, 1.62; 95% CI, 1.06-2.51; p=0.03; HR, 1.05; 95% CI, 0.70-1.63; p=0.79, respectively); regarding BARC class ≥3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30-3.88; p=0.004; HR, 2.25; 95% CI, 1.31-3.96; p=0.003; HR, 3.87; 95% CI, 2.06-7.91; p<0.0001; HR, 1.85; 95% CI, 1.04-3.47; p=0.04, respectively). In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class ≥3 bleeding events.
Sections du résumé
BACKGROUND
No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents.
METHODS
We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria.
RESULTS
TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class ≥3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15-2.64; p=0.01; HR, 1.63; 95% CI, 1.08-2.48; p=0.02; HR, 1.62; 95% CI, 1.06-2.51; p=0.03; HR, 1.05; 95% CI, 0.70-1.63; p=0.79, respectively); regarding BARC class ≥3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30-3.88; p=0.004; HR, 2.25; 95% CI, 1.31-3.96; p=0.003; HR, 3.87; 95% CI, 2.06-7.91; p<0.0001; HR, 1.85; 95% CI, 1.04-3.47; p=0.04, respectively).
CONCLUSIONS
In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class ≥3 bleeding events.
Identifiants
pubmed: 30598387
pii: S0914-5087(18)30360-5
doi: 10.1016/j.jjcc.2018.10.013
pii:
doi:
Substances chimiques
Anticoagulants
0
Platelet Aggregation Inhibitors
0
Types de publication
Evaluation Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
479-487Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.