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 .
Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel.
BACKGROUND Post-treatment platelet reactivity ( PR ) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists . OBJECTIVES We aim ed to study the relationship between post-treatment PR after a 60-mg loading dose ( LD ) of prasugrel and 1-year thrombotic and bleeding events . METHOD Patients were prospect ively included in this multicenter study if they had a successful percutaneous coronary intervention ( PCI ) for acute coronary syndrome ( ACS ) and received prasugrel .  The platelet reactivity index ( PRI ) was measured using the Vasodilator-Stimulated Phosphoprotein index ( VASP ) after a prasugrel LD . Endpoints included the rate of thrombotic events and bleeding events at 1 year . RESULTS Among the 301 patients enrolled , 9 ( 3 % ) were lost to follow-up at 1 year . The rates of thrombotic and bleeding events at 1 year were of 7.5 % and 6.8 % , respectively . Receiver-operating curve ( ROC ) analysis demonstrated an optimal cut-off value of 53.5 % of PRI to predict thrombotic events at 1 year . Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity ( HTPR ) had a higher rate of thrombotic events ( 22.4 % vs. 2.9 % ; P < 0.001 ) . In parallel the optimal cut-off value of PRI to predict bleeding was 16 % . Patients with a PRI ≤ 16 % had a higher rate of bleeding events compared with those with a PRI > 16 % ( 15.6 % vs. 3.3 % ; P < 0.001 ) . In multivariate analysis , the PRI predicted both thrombotic and bleeding events ( OR : 1.44 , 95 % confidence interval [ CI ] : 1.2 - 1.72 ; P < 0.001 and OR : 0.75 , 95 % CI : 0.59 - 0.96 ; P = 0.024 [ respectively , per 10 % increase ] ) . CONCLUSION Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI
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 .