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 .
Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial.
AIMS To evaluate the associations of myocardial infa rct ion ( MI ) and major bleeding with  1-year mortality .  Both MI and major bleeding predict 1-year mortality in patients presenting with acute coronary syndrome ( ACS ) . However , the risk of each of these events on the magnitude and timing of mortality has not been well studied . METHODS AND RESULTS A multivariable Cox regression model was developed relating 13 independent baseline predictors to 1-year mortality for 13 819 patients with moderate and high-risk ACS enrolled in the Acute Catheterization and Urgent Intervention Triage strategy trial . After adjustment for baseline predictors , Cox models with  major bleeding  and recurrent MI as time-up date d covariates estimated the effect of these events on mortality hazard over time . Within 30 days of r and omization , 705 patients ( 5.1 % ) had an MI , 645 ( 4.7 % ) had a major bleed ; 524 ( 3.8 % ) died within a year . The occurrence of an MI was associated with a hazard ratio of 3.1 compared with patients not yet having an MI , after adjustment for baseline predictors . However , MI within 30 days markedly increased the mortality risk for the first 2 days after the event ( adjusted hazard ratio of 17.6 ) , but this risk declined rapidly post-infa rct ( hazard ratio of 1.4 beyond 1 month after the MI event ) . In contrast , major bleeding had a prolonged association with mortality risk ( hazard ratio of 3.5 ) which remained fairly steady over time throughout 1 year . CONCLUSION After accounting for baseline predictors of mortality , major bleeds and MI have similar overall strength of association with mortality in the first year after ACS . MI is correlated with a dramatic increase in short-term risk , whereas major bleeding correlates with a more prolonged mortality 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 .