Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention

Abstract

Background: No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents. Methods: We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria. Results: TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class !3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15-2.64; p = 0.01; HR, 1.63; 95% CI, 1.08-2.48; p = 0.02; HR, 1.62; 95% CI, 1.06-2.51; p = 0.03; HR, 1.05; 95% CI, 0.70-1.63; p = 0.79, respectively); regarding BARC class !3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30-3.88; p = 0.004; HR, 2.25; 95% CI, 1.31-3.96; p = 0.003; HR, 3.87; 95% CI, 2.06-7.91; p < 0.0001; HR, 1.85; 95% CI, 1.04-3.47; p = 0.04, respectively). Conclusions: In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class !3 bleeding events.

Impact of Nutritional and Inflammation Status on Long-Term Bleeding in Patients Undergoing Percutaneous Coronary Intervention with an Oral Anticoagulant

“…The study population was first collected at single Japanese tertiary hospital to evaluate the predictive performance of various bleeding risk scores, and has been described previously 8) . In brief, among 3,718 patients who underwent PCI from April 2011 to March 2017, patients with indications for long-term OAC treatment were enrolled.…”

“…The details of the antithrombotic treatment also have been described previously 8) . All patients received at least one antiplatelet agent (thienopyridine [200 mg ticlopidine, 75 mg clopidogrel, or 3.75 mg prasugrel daily] and/or 81 – 100 mg aspirin daily) and an OAC (vitamin K antagonist or a direct OAC [DOAC]).…”

“…Bleeding event rates at 3 years were calculated using the Kaplan-Meier method and compared using the log-rank test. Since the PRECISE-DAPT score was best able to stratify bleeding events of patients who required both OACs and APT after PCI among four famous bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS scores) 8) , we adopted it as the reference bleeding score. Thus, a Cox proportional hazards model was used to estimate the contribution of the PRECISE-DAPT score, GNRI, and continuous values of hs-CRP levels to predict bleeding events.…”

“…Various prediction scores for bleeding events have been proposed for patients who are taking antithrombotic agents 4, 5) , and recently the PRECISEDAPT score has been developed 6) . However, the performance of these risk scores to detect bleeding events is moderate in patients who require both OACs and APT after PCI 7, 8) .…”

The Role of Novel Oral Anticoagulants and Antiplatelet Therapy after Percutaneous Coronary Intervention: Individualizing Therapy to Optimize Outcomes

“…Data support an ischemic benefit of DAPT only in patients with a PRECISE-DAPT score <25 16). Both bleeding risk prediction models have utility for predicting future significant bleeding events in patients taking an oral anticoagulants (OAC) and undergoing PCI 17)…”