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 .
Usefulness of platelet response to clopidogrel by point-of-care testing to predict bleeding outcomes in patients undergoing percutaneous coronary intervention (from the Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty-Bleeding Study).
Platelet reactivity predicts ischemic outcomes in patients who undergo percutaneous coronary intervention ( PCI ) , but the correlation of heightened platelet response with bleeding has not been characterized . The aim of this study was to evaluate whether low platelet reactivity by point-of-care measurement after clopidogrel administration correlates with bleeding complications of PCI . A total of 310 patients receiving clopidogrel before PCI were prospect ively enrolled .  Platelet reactivity was measured with the  VerifyNow P2Y12 assay . The primary end point was the 30-day incidence of major bleeding or entry-site complications according to quartile distribution of P2Y12 reaction units ( PRU ) . The primary end point occurred more frequently in patients with preprocedural PRU levels in the lowest quartile compared to those in the highest quartile ( 10.1 % vs 1.3 % , p = 0.043 ) , due mainly to entry-site hemorrhages . Absolute PRU levels were lower in patients with major bleeding ( 171 ± 49 vs 227 ± 68 in patients without , p = 0.002 ) . On multivariate analysis , pre-PCI PRU levels in the first quartile were associated with a 4.5-fold increased risk for major bleeding ( odds ratio 4.5 , 95 % confidence interval 1.9 to 25.9 , p = 0.01 ) . By receiver-operating characteristic curve analysis , the optimal cutoff for the primary end point was a pre-PCI PRU value ≤ 189 ( area under the curve 0.76 , 95 % confidence interval 0.66 to 0.87 , p = 0.001 ) . In conclusion , this study suggests that an enhanced response to clopidogrel may be associated with higher risk for early major bleeding or entry-site complications in patients who undergo PCI . Point-of-care monitoring of platelet reactivity after clopidogrel administration may help identify patients in whom individualized strategies are indicated to limit bleeding complications after coronary intervention
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 .