Assessment of bleeding risk in patients with coronary artery disease on dual antiplatelet therapy

Minka J. A. Vries; Paola E. J. van der Meijden; Yvonne M. C. Henskens; Arina J. ten Cate-Hoek; Hugo ten Cate

doi:10.1160/TH15-04-0355

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(01): 7-24
DOI: 10.1160/TH15-04-0355

Review Article

Schattauer GmbH Schattauer

Assessment of bleeding risk in patients with coronary artery disease on dual antiplatelet therapy

A systematic review

Minka J. A. Vries

¹Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht (MUMC), the Netherlands

,

Paola E. J. van der Meijden

¹Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht (MUMC), the Netherlands

,

Yvonne M. C. Henskens

¹Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht (MUMC), the Netherlands

²Central Diagnostic Laboratory, MUMC, the Netherlands

,

Arina J. ten Cate-Hoek

¹Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht (MUMC), the Netherlands

,

Hugo ten Cate

¹Laboratory for Clinical Thrombosis and Haemostasis, Departments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht (MUMC), the Netherlands

› Author Affiliations

Abstract

Summary

Patients with coronary artery disease are usually treated with dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. Patients on DAPT are at risk of both ischaemic and bleeding events. Although side-lined for a long time, real-life studies have shown that both the incidence and the associated morbidity and mortality of outof-hospital bleeding are high. This indicates that prevention of (postinterventional) bleeding is as important as prevention of ischaemia. For this purpose it is crucial to reliably identify patients with a high bleeding risk. In order to postulate an algorithm, which could help identifying these patients, we performed a systematic review to determine the value of previously proposed prognostic modalities for bleeding. We searched and appraised the following tools: platelet function tests, genetic tests, bleeding scores and questionnaires and haemostatic tests. Most studies indicated that low on-treatment platelet reactivity (LTPR), as measured by several platelet function tests, and the carriage of CYP2C19*17 allele were independent risk factors for bleeding. A bleeding score also proved to be helpful in identifying patients at risk. No studies on haemostatic tests were retrieved. Several patient characteristics were also identified as independent predictors of bleeding, such as older age, female sex and renal failure. Combining these risk factors we propose an algorithm that would hypothetically facilitate identification of those patients at highest risk, warranting prevention measures for bleeding. This could be a starting point for further research concerning the topic.

Keywords

Dual antiplatelet therapy - coronary artery disease - bleeding - prognostic tests

Full Text

References

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