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 .
Residual platelet reactivity, bleedings, and adherence to treatment in patients having coronary stent implantation treated with prasugrel.
Recent guidelines have recommended the use of aspirin and prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention . However , prasugrel use has been evaluated only in r and omized trials . This study sought to evaluate bleeding rates and adherence to treatment in " real-world " patients treated with prasugrel .  In total 298 consecutive patients 68 ± 10 years old ( 31 % > 75 years old ) underwent stent implantation and received prasugrel therapy .  Indications to prasugrel therapy were ( 1 ) ST-elevation acute myocardial infa rct ion ( 41 % ) , ( 2 ) drug-eluting stent implantation in diabetics ( 24 % ) , ( 3 ) stent thrombosis ( 3 % ) , ( 4 ) left main coronary artery drug-eluting stent implantation ( 6 % ) , and ( 5 ) percutaneous coronary intervention in patients with high residual platelet reactivity on clopidogrel therapy ( 26 % ) . All patients received a loading of prasugrel 60 mg . Patients ≥75 years old and with body weight ≤60 kg received a maintenance dose of 5 mg/day ( 10 mg/day for all the other patients ) . Follow-up data including adherence to prasugrel therapy were collected by telephone interviews or outpatient visits . Minimal follow-up length was 6 months ( mean 9 ± 3 ) . Major , minor , and minimal bleedings ( Thrombolysis In Myocardial Infa rct ion criteria ) occurred in 2.7 % , 4.7 % , and 15.1 % of enrolled patients . Low residual platelet reactivity ( p = 0.001 ) and female gender ( p = 0.29 ) were independent predictors of bleeding events . The most frequent minimal bleeding event was epistaxis . Only 8 patients ( 2.7 % ) permanently discontinued prasugrel therapy because of bleeding events ( n = 4 ) , possible side effects ( n = 2 ) , or medical decisions not associated with bleeding or side effects ( n = 2 ) . Fourteen patients ( 4.7 % ) temporarily discontinued prasugrel ( average 6.5 days ) mainly because of surgical procedures . No definite or probable stent thrombosis occurred , although 3 patients develop de novo myocardial infa rct ion and 1 an ischemic stroke . There were 11 deaths because of heart failure or refractory cardiogenic shock in 9 , pulmonary embolism in 1 , and cancer in 1 . In conclusion , in clinical practice , major and minor bleeding event rates associated with prasugrel therapy are comparable to those reported in controlled r and omized trials . The minimal bleeding event rate is higher than reported but does not seem to affect adherence to treatment
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 .