Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .
Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes.
Bleeding is a complication of current therapies for acute coronary syndrome ( ACS ) . No studies have examined the effect of bleeding events on clinical outcomes . We analyzed pooled data from 4 multicenter , r and omized clinical trials of patients who had ACS ( n = 26,452 ) to determine an association between bleeding severity as measured by the GUSTO scale and 30-day and 6-month mortality rates using Cox proportional hazards modeling that incorporated bleeding as a time-dependent covariate . The analysis was repeated to examine procedure- and non-procedure-related bleeding and after censoring at the time of coronary artery bypass grafting .  Of all the patients included , 27.6 % had > or = 1 bleeding episode .  Patients who bled were older and sicker at presentation than were those who did not bleed . Unadjusted rates of 30-day and 6-month mortality increased as bleeding severity increased . There were stepwise increases in the adjusted hazards of 30-day mortality ( mild bleeding , hazard ratio [ HR ] 1.6 , 95 % confidence interval [ CI ] 1.3 to 1.9 ; moderate bleeding , HR 2.7 , 95 % CI l 2.3 to 3.4 ; severe bleeding , HR 10.6 , 95 % CI 8.3 to 13.6 ) and 6-month mortality ( mild bleeding , HR 1.4 , 95 % CI 1.2 to 1.6 ; moderate bleeding , HR 2.1 , 95 % CI 1.8 to 2.4 ; severe bleeding , HR 7.5 , 95 % CI 6.1 to 9.3 ) as bleeding severity increased . Results were consistent after censoring for coronary artery bypass grafting and for procedure- and non-procedure-related bleeds . In conclusion , the GUSTO bleeding classification identifies patients who are at risk for short- and long-term adverse events . Therapies that minimize bleeding risk and maintain an anticoagulant effect may improve outcomes among patients who have ACS
Most studies indicated that low on-treatment platelet reactivity ( LTPR ) , as measured by several platelet function tests , and the carriage of CYP2C19 * 17 allele were independent risk factors for bleeding .
A bleeding score also proved to be helpful in identifying patients at risk .
Several patient characteristics were also identified as independent predictors of bleeding , such as older age , female sex and renal failure .
Patients with coronary artery disease are usually treated with dual antiplatelet therapy ( DAPT ) after percutaneous coronary intervention .
Patients on DAPT are at risk of both ischaemic and bleeding events .
Although side-lined for a long time , real-life studies have shown that both the incidence and the associated morbidity and mortality of out-of-hospital bleeding are high .
This indicates that prevention of ( post-interventional ) bleeding is as important as prevention of ischaemia .
For this purpose it is crucial to reliably identify patients with a high bleeding risk .
In order to postulate an algorithm , which could help identifying these patients , we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding .