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Predictive Value of HAS-BLED and HEMORR2HAGES Bleeding Risk Scores After Percutaneous Coronary Intervention
Ianis Doomun1, Daphné Doomun1, Sara Schukraft1
1Department of Cardiology, University and Hospital Fribourg, Fribourg, Switzerland.
Insights
The HEMORR2HAGES score better predicts bleeding risk in patients undergoing percutaneous coronary intervention (PCI) than HAS-BLED or PARIS scores. High bleeding risk also correlates with increased ischemic risk and mortality post-PCI.
Area of Science:
- Cardiology
- Clinical Risk Assessment
- Interventional Cardiology
Background:
- Existing bleeding risk scores like HAS-BLED and HEMORR2HAGES are widely used but have limited validation in patients undergoing percutaneous coronary intervention (PCI).
- Accurate bleeding risk assessment is crucial for managing patients post-PCI, especially those on antithrombotic therapy.
Purpose of the Study:
- To evaluate and compare the predictive performance of HAS-BLED, HEMORR2HAGES, and PARIS bleeding risk scores in patients undergoing PCI.
- To assess the association between bleeding risk scores and major bleeding events or patient-oriented composite endpoints over a 2-year follow-up.
Main Methods:
- A prospective study of 1,080 consecutive patients undergoing PCI between 2015 and 2017.
- Bleeding risk scores (HAS-BLED, HEMORR2HAGES, PARIS) were calculated at baseline.
- Patients were followed for 2 years to record major bleeding events (BARC types 3-5) and patient-oriented composite endpoints.
Main Results:
- All evaluated bleeding risk scores demonstrated statistically significant predictive ability for bleeding events.
- The HEMORR2HAGES score showed superior performance (C-statistic=0.73) compared to HAS-BLED (C-statistic=0.66) and PARIS (C-statistic=0.66) for predicting major bleeding.
- Patients categorized as high-risk for bleeding experienced a greater incidence of patient-oriented composite endpoints.
Conclusions:
- HEMORR2HAGES, HAS-BLED, and PARIS scores are effective in predicting bleeding events after PCI.
- Elevated bleeding risk in PCI patients is associated with increased ischemic risk and higher 2-year mortality.
Background:
Various scoring systems have been developed to assess the risk of bleeding in medical settings. HAS-BLED and HEMORR2HAGES risk scores are commonly used to estimate bleeding risk in patients receiving anticoagulation for atrial fibrillation, but data on their predictive value in patients undergoing percutaneous coronary intervention (PCI) are limited.
Methods:
This study evaluated and compared the predictive abilities of the HAS-BLED and HEMORR2HAGES bleeding risk scores in all-comer patients undergoing PCI. The PARIS score, specifically designed for patients undergoing PCI, was used as a comparator. The scores were calculated at baseline and compared with the occurrence of events during a 2-year clinical follow-up period. Between 2015 and 2017, all consecutive patients undergoing PCI we re prospectively enrolled and divided into risk tertiles based on bleeding risk scores. The primary end points were hierarchical major bleeding events, defined by Bleeding Academic Research Consortium types 3 through 5, and patient-oriented composite end points according to Bleeding Academic Research Consortium classification, which were assessed during the 2-year follow-up period.
Results:
A total of 1,080 patients completed the follow-up period. Two years after index, 189 patients (17.5%) had experienced any bleeding, with 48 events (4.4%) classified as Bleeding Academic Research Consortium types 3 to 5. All bleeding risk scores showed statistically significant predictive ability for bleeding events. The HEMORR2HAGES score (C statistic, 0.73) was more effective than the HAS-BLED score (C statistic, 0.66; P = .07) and the PARIS score (C statistic, 0.66; P = .06) in predicting risk of major bleeding. Patients in high-risk bleeding groups also experienced a higher incidence of patient-oriented composite end points.
Conclusions:
The HEMORR2HAGES, HAS-BLED, and PARIS risk scores exhibited good predictive abilities for bleeding events following PCI. Patients at high risk of bleeding also demonstrated increased ischemic risk and higher mortality during the 2-year follow-up period.
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