External validation of bleeding risk models for the prediction of long-term bleeding risk in patients with established cardiovascular disease

Castelijns, Maria C; Hageman, Steven H J; Teraa, Martin; Meer, Manon G van der; Westerink, Jan; Costa, Francesco; Berg, Jürrien M. ten; Visseren, Frank L J

doi:10.1016/j.ahj.2023.02.011

Cited by 7 publications

(3 citation statements)

References 35 publications

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“…In patients identified at high risk (score ≥ 25), a longer DAPT duration significantly increased bleeding, but not in those with lower risk profiles [92]. Multiple external validations of this prediction tool have been presented, largely confirming the score discriminative ability [93,94].…”

Section: Optimal Dapt Duration In Hbr Patientsmentioning

confidence: 74%

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

Carciotto,

Costa,

Garcia-Ruiz

et al. 2023

JCM

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Dual antiplatelet therapy (DAPT), comprising aspirin and a P2Y12 receptor inhibitor, is the cornerstone of post-percutaneous coronary intervention treatment to prevent stent thrombosis and reduce the risk of adverse cardiovascular events. The selection of an optimal DAPT regimen, considering the interplay of various antiplatelet agents, patient profiles, and procedural characteristics, remains an evolving challenge. Traditionally, a standard duration of 12 months has been recommended for DAPT in most patients. While contemporary guidelines provide general frameworks, DAPT modulation with longer or shorter treatment courses followed by aspirin or P2Y12 inhibitor monotherapy are evolving towards an individualized strategy to optimize the balance between efficacy and safety. This review comprehensively examines the current landscape of DAPT strategies after coronary stenting, with a focus on emerging evidence for treatment individualization.

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Section: Optimal Dapt Duration In Hbr Patientsmentioning

confidence: 74%

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

Carciotto,

Costa,

Garcia-Ruiz

et al. 2023

JCM

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“…They can be valuable in risk stratification and treatment decision-making for other cardiovascular diseases and acute coronary syndromes without PCI. These scores have been associated with adverse outcomes and can guide the selection of antiplatelet regimens in different treatment modalities [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive value of PRECISE-DAPT score for long-term all-cause mortality in atrial fibrillation patients with non-ST-elevation myocardial infarction

Polat,

Yaylak,

Onuk

et al. 2023

pwki

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Introduction Atrial fibrillation (AF) may co-exist in patients with non-ST-elevation myocardial infarction (NSTEMI). In patients with NSTEMI, AF should therefore be regarded as an important risk factor irrespective of its presentation. To predict outcomes in AF patients presenting with NSTEMI, early risk stratification can help to identify the patients with a possible poor long-term prognosis. The development of the PRECISE-DAPT score aimed to predict the risk of bleeding in patients who underwent stent implantation and received dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), providing a valuable tool for assessing bleeding risk in this specific patient population. Aim To assess the performance of the PRECISE-DAPT score in predicting long-term prognosis in AF patients with NSTEMI. Material and methods Five hundred and twenty-six consecutive AF patients presenting with NSTEMI were included in the present study. The PRECISE-DAPT score was calculated in each case and evaluated for the association of increased mortality in the study population, who survived in-hospital but died in the long term. Results All-cause mortality deaths occurred in 278 (52.6%) patients. Higher PRECISE-DAPT score, shorter duration of P2Y12 inhibitor therapy, decreased left ventricular ejection fraction (LVEF), and a history of diabetes mellitus (DM) were all associated with an increased risk of all-cause mortality in the multivariable logistic regression model. Conclusions High PRECISE-DAPT score was associated with higher long-term all-cause mortality in AF patients presenting with NSTEMI.

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“…Almost all interviewed clinicians recalled a major adverse bleeding event in a patient after endovascular intervention. Due to consensus that bleeding risk scores are not routinely applied in the clinical management of PAD patients, coupled with the absence of a validated bleeding risk model for patients with PAD, 52 the assessment of bleeding risk of patients was left broad, to allow discretion-based assessment by individual respondents. Bleeding risk in the DCE was dichotomised into ‘low bleeding risk’ and ‘moderate bleeding risk’.…”

Section: Methods and Analysismentioning

confidence: 99%

Prescriber decision-making on antithrombotic therapy after endovascular intervention for peripheral artery disease: a protocol for a discrete choice experiment

Zhu,

Tang,

Rajendran

et al. 2024

BMJ Open

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IntroductionPeripheral artery disease (PAD) is a major risk factor for cardiovascular morbidity and mortality, despite surgical and endovascular treatments. Emerging evidence supports the use of immediate antithrombotic medications after endovascular intervention for PAD, however, there is a lack of consensus regarding choice and duration of antithrombotic therapy. Prescriber decision-making is a complex process, with prior studies demonstrating patient factors can influence variability in antithrombotic therapy for PAD. However, it remains unclear the relative contribution of these factors. This paper describes a planned study that aims to (1) determine the influence of patient factors on clinician preference for antithrombotic therapy following endovascular intervention and (2) compare differences in prescribing preferences between consultant vascular surgeons and trainees.Methods and analysisThis cross-sectional survey will evaluate antithrombotic prescribing choices using a discrete choice experiment (DCE) that has been developed and piloted for this study. A list of attributes and levels was generated using a mixed-methods approach. This included an extensive literature review and semistructured interviews with prescribing clinicians. Following final selection of included attributes, specialised software was used to construct a D-efficient design for the DCE questionnaire. The electronic questionnaire will be administered to vascular trainees and consultant surgeons across Australia. These data will be analysed using multinomial logistic regression, treating the decision to prescribe antithrombotic therapy as a function of both the attributes of the two alternatives, as well as characteristics of the respondent. Latent class analysis will be used to explore heterogeneity of responses.Ethics and disseminationEthics approval was obtained from the University of Sydney Human Ethics committee (2023/474). The results of this study will be published in peer-reviewed journals and presented at national vascular surgical conferences. These results will be used to improve understanding how clinicians make prescribing decisions and to inform future strategy to enhance guideline-directed prescribing.

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External validation of bleeding risk models for the prediction of long-term bleeding risk in patients with established cardiovascular disease

Cited by 7 publications

References 35 publications

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

Predictive value of PRECISE-DAPT score for long-term all-cause mortality in atrial fibrillation patients with non-ST-elevation myocardial infarction

Prescriber decision-making on antithrombotic therapy after endovascular intervention for peripheral artery disease: a protocol for a discrete choice experiment

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