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Predictors of bleeding in patients with acute coronary syndromes treated with prasugrel
Petr Widimsky1, Zuzana Motovska1, Leonardo Bolognese2
1Cardiocenter, Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic.
Insights
Predictors of bleeding risk in non-ST-segment elevation myocardial infarction (NSTEMI) patients treated with antiplatelet therapy were identified. Pretreatment with prasugrel, older age, female sex, and procedural factors increased bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Balancing the benefits of antiplatelet therapy (reduced thrombotic events) against bleeding risks is crucial in acute coronary syndrome (ACS).
- Intense platelet inhibition via P2Y12 receptor antagonism is associated with increased bleeding.
- Identifying predictors of bleeding events is essential for optimizing patient care in ACS.
Purpose of the Study:
- To identify independent predictors of bleeding events in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
- To analyze bleeding risk factors within the ACCOAST study population receiving prasugrel therapy.
Main Methods:
- The ACCOAST study randomized 4033 NSTEMI patients to different prasugrel dosing strategies.
- Independent predictors of Thrombolysis in Myocardial Infarction (TIMI) major bleeding (not related to coronary artery bypass grafting) were assessed.
- A stepwise Cox proportional model was used to analyze time to first bleeding event.
Main Results:
- Non-CABG-related TIMI major bleeding occurred in 0.9% of patients, and major or minor bleeding in 2.0%.
- Independent predictors for major bleeding included pretreatment with prasugrel loading dose, femoral access, female sex, placement of >1 stent, and age.
- Predictors for major or minor bleeding included pretreatment with prasugrel loading dose, femoral access, female sex, performed PCI, glycoprotein IIb/IIIa inhibitors, and age.
Conclusions:
- Pretreatment with prasugrel, older age, female gender, and specific procedural variables were identified as predictors of bleeding risk in NSTEMI patients.
- These findings aid in stratifying bleeding risk and guiding antiplatelet therapy decisions in NSTEMI management.
Background:
When considering antiplatelet therapy for acute coronary syndrome (ACS), it is essential to balance benefits (less thrombotic/ischaemic events) versus bleeding risks related to intense platelet inhibition via antagonism of P2Y12 receptors. This analysis aimed to identify predictors of bleeding events among A Comparison of Prasugrel at the Time of PCI or as Pretreatment at the Time of Diagnosis in Patients with NSTEACS (ACCOAST) study population.
Methods And Results:
The ACCOAST study randomised 4033 patients with non-ST-segment elevation myocardial infarction (NSTEMI) to (A) a 30 mg prasugrel loading dose (LD) followed by coronary angiography with an additional 30 mg prasugrel at the time of percutaneous coronary intervention (PCI) or (B) a placebo LD followed by a 60 mg prasugrel at the time of PCI. Patients received standard of care, including use of aspirin. Independent predictors of Thrombolysis in Myocardial Infarction (TIMI) major bleeding not related to coronary artery bypass grafting (CABG) within 7 days were assessed using stepwise Cox proportional model for time to first occurrence of the event. Non-CABG-related TIMI major or minor bleeding was similarly analysed. Non-CABG-related TIMI major bleeding occurred in 36 (0.9%) patients, and TIMI major or minor bleeding occurred in 81 (2.0%) patients. Independent predictors for TIMI major bleeding alone were pretreatment with prasugrel LD (HR 3.02; 95% CI 1.42 to 6.43), femoral access (HR 2.45; 95% CI 1.11 to 5.38), female sex (HR 2.57; 95% CI 1.32 to 5.00), placement of >1 stent (HR 2.50; 95% CI 1.26 to 4.95) and age (HR 1.05; 95% CI 1.02 to 1.09). Pretreatment with prasugrel LD (HR 3.05; 95% CI 1.84 to 5.07), femoral access (HR 3.06; 95% CI 1.74 to 5.38), female sex (HR 2.62; 95% CI 1.67 to 4.12), performed PCI (HR 2.21; 95% CI 1.23 to 3.99), therapy with glycoprotein IIb/IIIa inhibitors (HR 1.88; 95% CI 1.06 to 3.33) and age (increased bleed per year of age HR 1.04; 95% CI 1.02 to 1.06) were independent predictors of TIMI major or minor bleeding through 7 days.
Conclusions:
Pretreatment, age, gender and procedural variables predicted bleeding risk in patients with NSTEMI.
Clinical Registration No:
NCT01015287.
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