Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention

Pelliccia, Francesco; Gragnano, Felice; Pasceri, Vincenzo; Cesaro, Arturo; Zimarino, Marco; Calabrò, Paolo

doi:10.3390/jcm11133574

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Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention

by

Francesco Pelliccia

^1,*,†

,

Felice Gragnano

^2,3,†,

Vincenzo Pasceri

⁴,

Arturo Cesaro

^2,3

,

Marco Zimarino

^5,6 and

Paolo Calabrò

^2,3

¹

Department of Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, 00166 Rome, Italy

²

Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale ‘Sant’Anna e San Sebastiano’, 81100 Caserta, Italy

³

Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 80131 Naples, Italy

⁴

Interventional Cardiology, San Filippo Neri Hospital, 00135 Rome, Italy

⁵

Institute of Cardiology, “G. d’Annunzio” University, 66100 Chieti, Italy

⁶

Cath Lab, Ospedale Policlinico SS. Annunziata Annunziata Hospital, 66100 Chieti, Italy

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2022, 11(13), 3574; https://doi.org/10.3390/jcm11133574

Submission received: 31 May 2022 / Revised: 17 June 2022 / Accepted: 20 June 2022 / Published: 21 June 2022

(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors, Comorbidities, and Prevention)

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Abstract

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ receptor inhibitor in patients undergoing percutaneous coronary intervention (PCI) reduces the risk of ischemic events but reduces the risk of ischemic events but increases the risk of bleeding, which in turn is associated with increased morbidity and mortality. With the aim to offer personalized treatment regimens to patients undergoing PCI, much effort has been devoted in the last decade to improve the identification of patients at increased risk of bleeding complications. Several clinical scores have been developed and validated in large populations of patients with coronary artery disease (CAD) and are currently recommended by guidelines to evaluate bleeding risk and individualize the type and duration of antithrombotic therapy after PCI. In clinical practice, these risk scores are conventionally computed at the time of PCI using baseline features and risk factors. Yet, bleeding risk is dynamic and can change over time after PCI, since patients can worsen or improve their clinical status and accumulate comorbidities. Indeed, evidence now exists that the estimated risk of bleeding after PCI can change over time. This concept is relevant, as the inappropriate estimation of bleeding risk, either at the time of revascularization or subsequent follow-up visits, might lead to erroneous therapeutic management. Serial evaluation and recalculation of bleeding risk scores during follow-up can be important in clinical practice to improve the identification of patients at higher risk of bleeding while on DAPT after PCI.

Keywords: bleeding; dual antiplatelet therapy; percutaneous coronary intervention risk score

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MDPI and ACS Style

Pelliccia, F.; Gragnano, F.; Pasceri, V.; Cesaro, A.; Zimarino, M.; Calabrò, P. Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention. J. Clin. Med. 2022, 11, 3574. https://doi.org/10.3390/jcm11133574

AMA Style

Pelliccia F, Gragnano F, Pasceri V, Cesaro A, Zimarino M, Calabrò P. Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention. Journal of Clinical Medicine. 2022; 11(13):3574. https://doi.org/10.3390/jcm11133574

Chicago/Turabian Style

Pelliccia, Francesco, Felice Gragnano, Vincenzo Pasceri, Arturo Cesaro, Marco Zimarino, and Paolo Calabrò. 2022. "Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention" Journal of Clinical Medicine 11, no. 13: 3574. https://doi.org/10.3390/jcm11133574

APA Style

Pelliccia, F., Gragnano, F., Pasceri, V., Cesaro, A., Zimarino, M., & Calabrò, P. (2022). Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention. Journal of Clinical Medicine, 11(13), 3574. https://doi.org/10.3390/jcm11133574

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Risk Scores of Bleeding Complications in Patients on Dual Antiplatelet Therapy: How to Optimize Identification of Patients at Risk of Bleeding after Percutaneous Coronary Intervention

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