Ischemic and bleeding risk are overestimated by physicians in patients at low risk and are underestimated in those at high risk from such complications. Risk stratification scores provide superior discrimination of future ischemic events compared with that estimated by physicians only in very high-risk patients; conversely, bleeding risk evaluation appears poor either when objectively calculated or perceived by clinicians. A short duration of dual antiplatelet therapy (SDAPT) is associated with a reduction in bleeding complications, but is less protective from ischemic events. The use of risk scores may be useful for risk assessment, and guiding SDAPT, both for stable coronary artery disease and acute coronary syndromes (ACS), and should be considered in patients at high bleeding risk.
We aimed to compare in patients undergoing percutaneous coronary intervention the bleeding risk at hospital discharge as perceived by the treating physician with that calculated using 4 different bleeding risk stratification scores; furthermore, we investigated the influence of the perceived and calculated high bleeding risk on the prescription of a SDAPT and only for patients with ACS, on the choice of the P2Y12 inhibitor (clopidogrel versus prasugrel or ticagrelor).
Ferlini M, Rossini R, Musumeci G, Grieco N, Demarchi A, Trabattoni D, Zavalloni Parenti D, Pierini S, Castiglioni B, Somaschini A, Cornara S, Lettieri C, Oltrona Visconti L. Perceived or Calculated Bleeding Risk and Their Relation With Dual Antiplatelet Therapy Duration in Patients Undergoing Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019 Jun;12(6):e007949. doi: 10.1161/CIRCINTERVENTIONS.119.007949.