A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes

Mehran, Roxana; Pocock, Stuart J.; Nikolsky, Eugenia; Clayton, Tim; Dangas, George; Kirtane, Ajay J.; Parise, Helen; Fahy, Martin; Manoukian, Steven V.; Feit, Frederick; Öhman, Magnus; Witzenbichler, Bernard; Guagliumi, Giulio; Lansky, Alexandra J.; Stone, Gregg W.

doi:10.1016/j.jacc.2009.09.076

Cited by 603 publications

(427 citation statements)

References 43 publications

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“…Poważne krwawienia są związane ze zwiększoną śmier-telnością w NSTE-ACS [104,105]. Skale ryzyka krwawienia powstały na podstawie danych z rejestrów lub kohort badawczych dotyczących ACS i PCI.…”

Section: Ocena Ryzyka Krwawieniaunclassified

“…Skala ryzyka Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) pochodzi z puli kohorty 17 421 pacjentów z ACS (zarówno z NSTE-ACS, jak i STEMI) włączonych do badań ACUITY i Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) [104]. Zidentyfikowano 6 niezależnych, wyjściowych czynników predykcyjnych (tj.…”

Section: Ocena Ryzyka Krwawieniaunclassified

See 1 more Smart Citation

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

210

172

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Section: Ocena Ryzyka Krwawieniaunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

210

172

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“…In particular, the potency and duration of dual antiplatelet therapy (DAPT) after coronary stenting are currently based mainly on the patient's clinical presentation (ie, acute coronary syndrome or stable coronary artery disease) and the type of stent used (ie, drug‐eluting or bare metal stent), with evanescent indications based on the patient's bleeding risk 7, 8, 9. Many bleeding risk scores have been validated for the prediction of early and late bleeding events, and some have been tested on large cohorts with acute coronary syndrome, demonstrating reasonably good performance 10, 11, 12. Among them, the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA [American College of Cardiology/American Heart Association] Guidelines) score has been validated in 17 857 patients with non–ST‐segment elevation myocardial infarction (MI), and its predictive capability was consistent in terms of hemorrhagic risks in patients taking ≥2 antithrombotic medications 10.…”

Section: Introductionmentioning

confidence: 99%

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Costa

Tijssen

Ariotti

et al. 2015

JAHA

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BackgroundMultiple scores have been proposed to stratify bleeding risk, but their value to guide dual antiplatelet therapy duration has never been appraised. We compared the performance of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HAS‐BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) scores in 1946 patients recruited in the Prolonging Dual Antiplatelet Treatment After Grading Stent‐Induced Intimal Hyperplasia Study (PRODIGY) and assessed hemorrhagic and ischemic events in the 24‐ and 6‐month dual antiplatelet therapy groups.Methods and ResultsBleeding score performance was assessed with a Cox regression model and C statistics. Discriminative and reclassification power was assessed with net reclassification improvement and integrated discrimination improvement. The C statistic was similar between the CRUSADE score (area under the curve 0.71) and ACUITY (area under the curve 0.68), and higher than HAS−BLED (area under the curve 0.63). CRUSADE, but not ACUITY, improved reclassification (net reclassification index 0.39, P=0.005) and discrimination (integrated discrimination improvement index 0.0083, P=0.021) of major bleeding compared with HAS‐BLED. Major bleeding and transfusions were higher in the 24‐ versus 6‐month dual antiplatelet therapy groups in patients with a CRUSADE score >40 (hazard ratio for bleeding 2.69, P=0.035; hazard ratio for transfusions 4.65, P=0.009) but not in those with CRUSADE score ≤40 (hazard ratio for bleeding 1.50, P=0.25; hazard ratio for transfusions 1.37, P=0.44), with positive interaction (P int=0.05 and P int=0.01, respectively). The number of patients with high CRUSADE scores needed to treat for harm for major bleeding and transfusion were 17 and 15, respectively, with 24‐month rather than 6‐month dual antiplatelet therapy; corresponding figures in the overall population were 67 and 71, respectively.ConclusionsOur analysis suggests that the CRUSADE score predicts major bleeding similarly to ACUITY and better than HAS BLED in an all‐comer population with percutaneous coronary intervention and potentially identifies patients at higher risk of hemorrhagic complications when treated with a long‐term dual antiplatelet therapy regimen.Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00611286.

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“…43 Monitoring for arterial bleeding is particularly important in high-risk groups such as elderly patients, women, those with renal dysfunction, and those who had a STEMI. 43,44 Monitoring should include regular assessment of wound or vascular-access sites, pain, peripheral pulses, vital signs, heart rhythm, and fluid intake and output. 45 Bleeding should be suspected in any hypotensive patient who has recently received coronary angiography, PCI, CABG, or other surgery in a background of antiplatelet therapy.…”

Section: Postprocedural Bleedingmentioning

confidence: 99%

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

Bobadilla

2016

Critical Care Nurse

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The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non–ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration. Nurses caring for patients with acute coronary syndrome must have a good understanding of the current treatment guidelines for such patients, to help ensure delivery of evidence-based care. This review article uses a case study–based approach to describe how the new guidelines affect clinical decision making when choosing appropriate antiplatelet therapy for patients with NSTE-ACS or STEMI, depending on the patient’s clinical history and presenting characteristics.

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A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes

Cited by 603 publications

References 43 publications

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Acute Coronary Syndrome: Focus on Antiplatelet Therapy

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