Bleeding Risk Profile in Patients on Oral Anticoagulation Undergoing Percutaneous Coronary Interventions: A...

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• The Academic Research Consortium (ARC) established criteria for high bleeding risk (HBR) to standardize patient assessment.
• Oral anticoagulation (OAC) is a frequent major criterion in the ARC-HBR definition.
• Identifying patients at elevated bleeding risk is crucial for optimizing antithrombotic therapy.

Purpose of the Study:

• To quantify bleeding risk in patients on OAC with at least one additional major ARC-HBR criterion.
• To compare bleeding rates between OAC patients with and without additional major ARC-HBR criteria.
• To evaluate the clinical utility of ARC-HBR criteria in predicting bleeding events post-percutaneous coronary intervention (PCI).

Main Methods:

• Prospective inclusion of consecutive patients undergoing PCI in the Cardio-Fribourg registry (2015-2017).
• Study population comprised patients on long-term OAC planned for triple antithrombotic therapy.
• Patients were stratified into two groups: those with and without additional major ARC-HBR criteria.

Main Results:

• A total of 142 high bleeding risk OAC patients completed follow-up; 33 (23%) had additional major ARC-HBR criteria.
• The primary endpoint (any bleeding) occurred in 55% of patients with additional criteria vs. 14% without (HR, 3.88; P < 0.01).
• Patients with additional criteria had significantly higher rates of Bleeding Academic Research Classification (BARC) ≥3 events (39% at 24 months).

Conclusions:

• The presence of at least one additional ARC-HBR criterion identifies OAC patients at very high risk of bleeding.
• These findings highlight the importance of comprehensive bleeding risk assessment in patients undergoing PCI on OAC.
• Risk stratification using ARC-HBR criteria can guide therapeutic decisions and potentially mitigate bleeding complications.