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Published on: August 9, 2024
[Validation of a score for predicting bleeding events during acute coronary syndromes]
Luis C L Correia1, Saulo Merelles, Ana Vasconcelos
1Hospital Português, Escola Bahiana de Medicina, Salvador, BA, Brasil. lccorreia@terra.com.br
Insights
A new bleeding risk score helps predict hemorrhagic complications in acute coronary syndromes (ACS) patients. This tool aids clinicians in balancing antithrombotic therapy benefits against bleeding risks for better patient outcomes.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Hemorrhagic Complications
Background:
- Bleeding is a significant complication for acute coronary syndromes (ACS) patients undergoing antithrombotic and invasive treatments.
- Balancing treatment benefits against bleeding risks is crucial for patient management.
- A validated bleeding risk score can aid clinical decision-making.
Purpose of the Study:
- To develop and validate a risk score for predicting bleeding events in ACS patients.
- To identify independent predictors of bleeding in ACS patients.
Main Methods:
- Utilized independent predictors of bleeding from the GRACE Registry to create a scoring system.
- Assigned points based on odds ratios of variables like previous bleeding history, creatinine clearance, age, and smoking status.
- Validated the score in a cohort of 383 ACS patients, defining in-hospital bleeding by hematocrit fall, transfusion, or fatal bleeding.
Main Results:
- The developed score demonstrated predictive ability for bleeding events (C-statistic = 0.66).
- Patients with a score > 7 had a 6% incidence of bleeding, versus 1.9% for scores < 7 (RR = 3.2).
- A score > 7 interacted with increased bleeding risk from Clopidogrel, IIb/IIIa blockers, and surgical revascularization.
Conclusions:
- The created bleeding risk score effectively discriminates bleeding risk in ACS patients.
- This score is a potentially valuable tool for clinical decision-making in ACS management.
Background:
bleeding is a major complication in patients treated for acute coronary syndromes (ACS) with antithrombotic and invasive therapies. Consequently, the benefit of such therapies should be balanced against the potential risk of hemorrhagic complications. Therefore, a score to estimate individual risk of bleeding might represent an important tool in clinical decision-making.
Objective:
this study aims to create and validate a bleeding risk score for patients with ACS.
Methods:
independent predictors of bleeding reported by the GRACE Registry were utilized. Variables with odds ratio (OR) > 2.5 in that Registry added 3 points (previous history of bleeding), OR = 1.5-2.4 added 2 points (creatinine clearance < 30 ml/min, female gender) and those with OR < 1.5 added 1 point (clearance between 30 and 60 ml/min, each 10 years of age>30, ST-deviation, peripheral artery disease and smoking). The score was validated in a cohort of 383 individuals with ACS. In-hospital bleeding was defined as hematocrit fall > 10%, blood transfusion > 2 units, intracerebral bleeding or fatal bleeding.
Results:
the incidence of bleeding events was 3.1% and the score's C-statistics was 0.66 (95% CI = 0.52-0.80), indicating a predictive ability towards these events. Those with a score > 7 had 6% incidence of bleeding, compared with 1.9% if the score was < 7 (RR = 3.2; 95%CI = 1.04-9.9; p = 0.03). There was an interaction between a score > 7 and greater risk imposed by treatment with Clopidogrel (p = 0.02), IIb/IIIa blockers (p = 0.06) and surgical revascularization (p < 0.001).
Conclusion:
the score discriminates bleeding risk and is potentially useful in clinical decision-making during ACS.
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