scholarly journals Prediction of Thrombotic and Bleeding Events After Percutaneous Coronary Intervention: CREDO‐Kyoto Thrombotic and Bleeding Risk Scores

2018 ◽  
Vol 7 (11) ◽  
Author(s):  
Masahiro Natsuaki ◽  
Takeshi Morimoto ◽  
Kyohei Yamaji ◽  
Hirotoshi Watanabe ◽  
Yusuke Yoshikawa ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Bleeding Events ◽  
Percutaneous Coronary

Abstract 12614: Total Thrombus Formation Analysis System Can Predict High Bleeding Risk in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobuhiro Nakanishi ◽  
Koichi Kaikita ◽  
Kenichi Tsujita
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Thrombus Formation ◽  
Academic Research ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Analysis System ◽  
Research Consortium ◽  
High Bleeding Risk

Introduction: Antithrombotic therapy is established for the treatment in various cardiovascular events, however, it has shown to increase the bleeding risk. Total Thrombus-formation Analysis System (T-TAS) is reported to be useful for evaluating thrombogenicity. Hypothesis: We examined whether T-TAS might predict 1-year bleeding risk in patients undergoing percutaneous coronary intervention (PCI). Methods: This was a retrospective, observational study at Kumamoto University Hospital between April 2017 and March 2019. Blood samples obtained on the day of PCI were used in T-TAS to compute the thrombus formation area under the curve (AUC) (AR10-AUC30, AUC for AR chip). We divided the study population into 2 groups according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) (182 patients in ARC-HBR positive, 118 in ARC-HBR negative). The primary endpoint was 1-year bleeding events that were defined by Bleeding Academic Research Consortium type2, 3, or 5. Results: The AR10-AUC30 levels were significantly lower in the ARC-HBR positive group than in the ARC-HBR negative group (median [interquartile range] 1568.1 [1258.5-1744.1] vs. 1723.1 [1567.0-1799.5], p<0.001). The combination of ARC-HBR and AR10-AUC30 could discriminate the bleeding risk, and improved predictive capacity compared with ARC-HBR by c-statistics and integrated discrimination improvement. In multivariate Cox hazards analyses, combining ARC-HBR and lower AR10-AUC30 levels were significantly associated with 1-year bleeding events. Decision curve analysis revealed that combining AR10-AUC30 with ARC-HBR ameliorated risk-prediction of bleeding events. Conclusions: The results highlighted that AR10-AUC30 could be a potentially useful marker for predicting high bleeding risk in patients undergoing PCI.

scholarly journals Clinical Utility of the BIWACO Score for Patients With Atrial Fibrillation After Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Teruki Takeda ◽  
Tomohiro Dohke ◽  
Yoshiki Ueno ◽  
Toshiki Mastui ◽  
Masanori Fujii ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Area Under The Curve ◽  
Dual Therapy ◽  
Coronary Intervention ◽  
Current Status ◽  
Risk Scores ◽  
Bleeding Events ◽  
Percutaneous Coronary ◽  
Multicenter Survey

Abstract Background: No predictive clinical risk scores for net adverse clinical events (NACE) have been developed in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Methods: We evaluated the NACE in order to develop clinically applicable risk-stratification scores in the BIWACO study, a multicenter survey which enrolled a total of 7837 patients. We also investigated the current status and time trends for the use of antithrombotic drugs.Results: A total of 188 AF patients who had received PCI were enrolled. At discharge, 65% of patients were prescribed a triple therapy (TT), 6% were prescribed a dual therapy, the remaining 29% of patients received dual-antiplatelet therapy. Over 3 years, the fraction of patients continuing TT decreased by 15%, whereas only 2% received oral anticoagulant alone. NACE developed in 20% of patients, resulting in the deaths of 5% patients, and 13% experiencing bleeding events. We developed risk scores for NACE comprising the five best predictive items, which we designated BIWACO scores. The area under the curve was 0.774 for NACE. Conclusions: Our study explored the differences in treatment practices and guideline recommendations for antithrombotic therapy. We concluded that our BIWACO score is useful for predicting clinical outcomes in AF-patients after PCI.

The Role of New Antiplatelet Agents in Percutaneous Coronary Intervention

2009 ◽  
Vol 4 (1) ◽  
pp. 81
Author(s):  
Benjamin Galper ◽  
Roxana Mehran ◽  
◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Hepatic Metabolism ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Thrombin Inhibitor ◽  
Antithrombotic Agents ◽  
Bleeding Events ◽  
Percutaneous Coronary

While the current armamentarium of antithrombotic agents used in the setting of percutaneous coronary intervention (PCI) has led to decreased mortality, re-infarction and recurrent ischaemia rates, there are also increasing rates of major bleeding events with the use of more potent antithrombotic agents. Major bleeding associated with PCI leads to significantly increased mortality. Additionally, adequate rates of antiplatelet activity are not reached in large proportions of patients receiving clopidogrel due to interactions with its hepatic metabolism. As a result, current research has focused on creating antiplatelet agents that bypass hepatic metabolism, such as prasugrel and ticagrelor, as well as on decreasing major bleeding risks in patients undergoing PCI. Large trials such as ACUITY and HORIZONS have demonstrated that the direct thrombin inhibitor bivalirudin is able to adequately anticoagulate patients undergoing urgent PCI while also significantly decreasing adverse bleeding events. Additionally, novel reversible anticoagulants and factor Xa inhibitors are being examined as agents that may reduce bleeding risk in this patient population.

Could the PARIS Risk Scores Be Useful for the Choice of Triple vs Dual Antithrombotic Therapy in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention?

Cardiology ◽  
2022 ◽  
Author(s):  
Leonardo De Luca ◽  
Leonardo Bolognese ◽  
Andrea Rubboli ◽  
Donata Lucci ◽  
Domenico Gabrielli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
Antithrombotic Therapy ◽  
Bleeding Risk ◽  
Daily Practice ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Thrombotic Risk ◽  
Percutaneous Coronary ◽  
Study Results

Introduction. Current guidelines recommend dual antithrombotic therapy (DAT) for the majority of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) and suggest a short course of triple antithrombotic therapy (TAT) for those at very high thrombotic risk (TR) but low bleeding risk (BR). Methods. We analyze if the PARIS ischemic-hemorrhagic scale could be useful for the choice of antithrombotic strategy in patients with acute coronary syndromes (ACS) and AF treated with coronary stenting enrolled in the prospective, observational, nationwide MATADOR-PCI study. Results. Among the 588 patients discharged alive, a TAT was prescribed in 381 (64.8%) and DAT in 52 (8.8%) patients. According to the PARIS scoring system, 142 (24.2%) were classified as low, 244 (41.5%) as intermediate and 292 (34.3%) as high TR. In parallel, 87 (14.8%) were categorized in the low, 260 (44.2%) in the intermediate and 241 (41.0%) in the high-risk stratum for major bleedings. Crossing the various strata of the two PARIS risk scores, the largest group of patients consisted of those at high TR and BR (n=130, 22%), followed by those at intermediate risk according to both scores (n=122, 21%). At discharge, TAT was mainly used in patients at intermediate to high BR, while DAT in those at intermediate to high TR but low BR, according to the PARIS score. Conclusion. Our data suggest that some variables associated with increased TR or BR are poorly considered in the daily practice while the use of PARIS scales could help in the implementation of guidelines' recommendations.

scholarly journals BLEEDING RISK SCORES AND IN-HOSPITAL OUTCOMES IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

2021 ◽  
Vol 77 (18) ◽  
pp. 950
Author(s):  
Vishnu Kadiyala ◽  
Sokunvichet Long ◽  
Fabio Lima ◽  
Charles Sherrod ◽  
Babak Tehrani ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Risk Scores ◽  
Hospital Outcomes ◽  
Percutaneous Coronary

Abstract 13287: The Clinical Value of Serum Albumin in Predicting Long-term Bleeding Events in Patients Who Underwent Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takuya Ando ◽  
Takeshi Shimizu ◽  
Joh Akama ◽  
Fumiya Anzai ◽  
Yuuki Muto ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Serum Albumin ◽  
Serum Albumin Level ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Albumin Level ◽  
Clinical Value ◽  
Bleeding Events ◽  
Percutaneous Coronary

Background: It has been known that East Asian people, including Japanese, has a high bleeding risk (HBR) than Western. Therefore, risk stratification is important to detect HBR patients among patients who underwent percutaneous coronary intervention (PCI). The aim of the present study was to investigate the association between serum albumin level and bleeding events in patients who underwent PCI. Methods and Results: Consecutive 1027 patients who underwent PCI and had been discharged from our institution were enrolled. We divided the patients into three groups based on serum albumin levels at discharge: the first tertile (≤3.7 g/dL, n=358), second tertile (3.8-4.1 g/dL, n=308) and third tertile (≥4.2 g/dL, n=361). Clinical characteristics of three groups were as follows: mean age (the first, second and third tertile; 72.9, 69.3 and 63.4 years, P<0.001), body mass index (23.4, 24.4 and 24.9 kg/m 2 , P<0.001), prevalence of male sex (70.7%, 78.6% and 87.1%, P<0.001), chronic kidney disease (53.8%, 39.3% and 27.1%, P<0.001), anemia (27.9%, 11.3% and 7.2%, P<0.001), atrial fibrillation (21.2%, 12.0% and 11.6%, P<0.001), peripheral artery disease (16.5%, 12.5% and 8.8%, P=0.021), stroke (23.2%, 17.9% and 9.6%, P<0.001), heart failure (54.1%, 28.1% and 21.7%, P<0.001), and use of anticoagulants (17.3%, 10.0% and 10.7%, P=0.007). In contrast, combination of antiplatelets did not differ among groups. In the Kaplan-Meier analysis (mean follow-up 1742 days), accumulated bleeding events progressively increased from the third tertile to the first tertile (Figure). The multivariable Cox proportional hazard analysis revealed that the first tertile (vs. third tertile) was independently associated with bleeding events in patients who underwent PCI (hazard ratio 3.080, 95% confidence interval 1.362-6.961, P=0.007). Conclusion: In patients who underwent PCI, low serum albumin level is independently associated with long-term bleeding events.

Abstract 13581: Prognostic Value of the Patterns of Non-adherence to Anti-platelet Regimen in Stented Patients (PARIS) Bleeding Risk Score for Long Term All-cause and Cardiac Mortalities After Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joh Akama ◽  
Takeshi Shimizu ◽  
Takuya Ando ◽  
Fumiya Anzai ◽  
Yuuki Muto ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Risk Score ◽  
Prognostic Value ◽  
Bleeding Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Percutaneous Coronary

Background: The Patterns of non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS) bleeding risk score has been proposed to predict the risk of bleeding events after percutaneous coronary intervention (PCI). However, the prognostic value of the PARIS bleeding risk score for long term all-cause and cardiac mortalities has not been evaluated. Therefore, we aimed to evaluate the predictive value of the PARIS bleeding risk score for all-cause and cardiac mortalities after PCI. Methods and Results: Consecutive 1061 patients, who had admitted to our hospital and performed or undergone PCI, were divided into 3 groups based on PARIS bleeding risk score: low (n = 113), intermediate (n = 420) and high risk groups (n = 528). We compared comorbidities and characteristics of patients among 3 groups. Furthermore, we prospectively followed up all-cause and cardiac mortalities. Clinical characteristics of 3 groups were as follows: mean age (low, intermediate and high risk groups; 56.5, 65.6 and 73.9 years, P < 0.001, respectively), prevalence of chronic kidney disease (2.7%, 24.2% and 67.8%, P < 0.001), atrial fibrillation (8.2%, 8.9% and 21.6%, P < 0.001) and peripheral artery disease (3.1%, 9.1% and 22.1%, P < 0.001). During the mean follow-up period of 1809 days, there were 205 deaths and 64 cardiac deaths. The Kaplan-Meier analysis revealed that both all-cause and cardiac mortalities were highest in high risk group among 3 groups (P < 0.001 and P < 0.001, respectively, Figure). In multivariable Cox proportional hazard analysis adjusted for confounding factors, PARIS bleeding score was an independent predictor of both all-cause and cardiac mortalities (adjusted hazard ratio 1.27 and 1.21 per 1 point increase, P < 0.001 and P = 0.004, respectively). Conclusion: The PARIS bleeding risk score showed significant prognostic values for all-cause and cardiac mortalities in patients after PCI.

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