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 .
Predictive value of post-treatment platelet reactivity for occurrence of post-discharge bleeding after non-ST elevation acute coronary syndrome. Shifting from antiplatelet resistance to bleeding risk assessment?
AIMS We assessed prospect ively the association between occurrence of post-discharge non-CABG-related TIMI major and minor bleeding  and post-treatment platelet reactivity in patients with non-ST elevation acute coronary syndrome ( NSTE ACS ) . METHODS AND RESULTS Five hundred and ninety-seven consecutive patients admitted with NSTE ACS were prospect ively included . Between hospital discharge and one month follow-up , we observed 16 ( 2.7 % ) non-CABG-related TIMI haemorrhagic complications including five ( 0.84 % ) major and 11 ( 1.8 % ) minor bleeds . Patients with bleeding had significantly lower post-treatment values of ADP-induced aggregation ( 43+/-14 % versus . 56+/-19 % , p=0.002 ) and platelet reactivity index VASP ( 43+/-14 % versus 54+/-23 % ; p=0.04 ) and a trend for lower values of arachidonic acid-induced aggregation ( 2.4+/-5.4 versus 13+/-21 ; p=0.27 ) . After stratification by quartiles based on post-treatment ADP-induced platelet aggregation , we identified patients in the first quartile as hyper-responders with very low post-treatment platelet reactivity , below < 40 % . The risk of TIMI major and minor bleeding was significantly higher in the first quartile of hyper-responders than in the others quartiles : 10 ( 6.6 % ) versus six ( 1.4 % ) , p=0.001 . CONCLUSIONS Our results suggest that assessment of post-treatment platelet reactivity might be used to detect hyper-responders to antiplatelet therapy with higher risk of non-CABG related bleeding and tailor antiplatelet therapy according to both ischaemic and bleeding risk
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 .