Abstract
Background: The Academic Research Consortium has identified a set of major and minor risk factors in order to standardize the definition of a high bleeding risk (ACR-HBR). Oral anticoagulation is a major criterion frequently observed.Aims: The objective of this study is to quantify the risk of bleeding in patients on oral anticoagulation with at least one additional major ACR-HBR criteria in the Cardio-Fribourg Registry.Methods: Between 2015 and 2017, consecutive patients undergoing percutaneous coronary intervention were prospectively included in the Cardio-Fribourg registry. The study population included patients with ongoing long-term oral anticoagulation (OAC) and planned to receive triple antithrombotic therapy. Patients were divided in two groups: patients on OAC with at least one additional major ACR-HBR criteria vs. patients on OAC without additional major ACR-HBR criteria. The primary endpoint was any bleeding during the 24-month follow-up. Secondary bleeding endpoint was defined as Bleeding Academic Research Classification (BARC) ≥3.Results: Follow-up was completed in 142 patients at high bleeding risk on OAC, of which 33 (23%) had at least one additional major ACR-HBR criteria. The rate of the primary endpoint was 55% in patients on OAC with at least one additional ACR-HBR criteria compared with 14% in patients on OAC without additional ACR-HBR criteria (hazard ratio, 3.88; 95%CI, 1.85–8.14; p < 0.01). Patients with additional major ACR-HBR criteria also experienced significantly higher rates of BARC ≥ 3 bleedings (39% at 24 months).Conclusion: The presence of at least one additional ACR-HBR criterion identifies patients on OAC who are at very high risk of bleeding after percutaneous coronary intervention.
Highlights
Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) [1]
Follow-up was completed in 142 patients at high bleeding risk on oral anticoagulation (OAC), of which 33 (23%) had at least one additional major ACR-HBR criteria
The rate of the primary endpoint was 55% in patients on OAC with at least one additional ACR-HBR criteria compared with 14% in patients on OAC without additional ACR-HBR criteria
Summary
Dual antiplatelet therapy (DAPT) is mandatory after percutaneous coronary intervention (PCI) [1]. An Academic Research Consortium (ARC) has identified a set of 12 risk factors in order to standardize the definition of a high risk of bleeding after PCI [6]. The ARC definition of High Bleeding Risk (ARC-HBR) is dichotomous, as patients are considered to be at high bleeding risk if at least one major or two minor criteria are met. A major criterion for ARC-HBR is expected to predict an incidence of Bleeding Academic Research Consortium (BARC) type 3–5 bleeding of ≥4% at 1 year and/or an intracranial hemorrhage risk (ICH) of ≥1% at 1 year after PCI. The Academic Research Consortium has identified a set of major and minor risk factors in order to standardize the definition of a high bleeding risk (ACR-HBR).
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