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 .
Increased risk of minor bleeding and antiplatelet therapy cessation in patients with acute coronary syndromes and low on-aspirin platelet reactivity. A prospective cohort study
Bleeding negatively affects prognosis and adherence to antiplatelet therapy  after acute coronary syndromes ( ACSs ) . The potential association of on-aspirin platelet reactivity and bleeding is not established . We sought to determine whether low on-aspirin platelet reactivity ( LAPR ) is associated with bleeding events and antiplatelet therapy compliance in patients with ACSs receiving coronary stenting . On-aspirin platelet reactivity was measured by the VerifyNow ™ Aspirin assay ( Accumetrics Inc. , San Diego , CA , USA ) in 531 patients with ACS . Cut-offs for LAPR were calculated by receiver-operating characteristic curve ( ROC ) analysis . Bleeding was reported according to Bleeding Academic Research Consortium ( BARC ) definition . The endpoints were minor bleeding ( BARC types 1 or 2 ) , major bleeding ( BARC types 3 or 5 ) and antiplatelet therapy cessation during 6-months follow-up . By ROC analysis the VerifyNow ™ Aspirin assay was able to distinguish between patients with and without minor bleeding ( area under the curve [ AUC ] 0.66 , 95 % confidence interval [ CI ] 0.62–0.70 , P < 0.0001 ) whereas major bleeding could not be predicted by the assay ( AUC 0.54 , 95 % CI 0.49–0.58 , P = 0.473 ) . By logistic regression , LAPR was associated with increased risk of minor bleeding ( odds ratio [ OR ] 4.32 , 95 % CI 2.78–6.71 , P < 0.0001 ) but not major bleeding ( OR 2.05 , 95 % CI 0.83–5.06 , P = 0.117 ) . Antiplatelet therapy discontinuation was more frequent in patients with LAPR as compared to those with no LAPR ( 21.6 vs. 9.1 % , P = 0.0008 ) . In conclusion , early point-of-care on-aspirin platelet reactivity testing in ACS may identify patients with increased risk of minor bleeding events and subsequent discontinuation of antiplatelet therapy . The possible impact of LAPR on major bleeding needs to be determined in larger trials
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 .