AUTHOR=Qian Yanxia , Xu Bing , Qian Xiaodong , Cao Lu , Cheng Yujia , Liu Xinjian , Bai Song , Han Zhijun , Wang Junhong 

TITLE=Incidence and Risk Factors for Antiplatelet Therapy–Related Bleeding Complications Among Elderly Patients After Coronary Stenting: A Multicenter Retrospective Observation

JOURNAL=Frontiers in Pharmacology

VOLUME=12

YEAR=2021

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.661619

DOI=10.3389/fphar.2021.661619

ISSN=1663-9812

ABSTRACT=<p><bold>Purpose:</bold> To determine the incidence and risk factors of bleeding events as well as assess the performance of the PRECISE-DAPT score in elderly patients (≥75 years) who underwent percutaneous coronary intervention (PCI) and one-year dual antiplatelet therapy (DAPT).</p><p><bold>Methods:</bold> A total of 940 patients (≥75 years) who received PCI and one-year DAPT were retrospectively enrolled into the study. The multivariable logistic regression analysis was conducted to identify risk factors of antiplatelet-related bleeding complications. The receiver operating characteristic (ROC) curve analysis and the Delong test were performed to obtain the optimized PRECISE-DAPT score.</p><p><bold>Results:</bold> It was observed that 89 (9.47%) patients suffered bleeding complications, while 37 (3.94%) of them had the Bleeding Academic Research Consortium (BARC, type ≥2) bleeding events. We stratified the PRECISE-DAPT score in tertiles (T1: ≤23; T2:24 to 32; T3: ≥33) and found that BARC ≥ 2 type bleeding occurred more frequently in T3 than in T1 and T2 (8.25 vs. 1.46% vs. 2.40%, <italic>p</italic> &lt;0.05). The ROC curve analysis revealed that the PRECISE-DAPT score cutoff for BARC ≥2 type bleeding prediction was 33. In comparison with the current recommended cutoff score of 25 (AUC: 0.608, based on ROC analysis), the Delong test indicated significantly improved ability for predicting BARC ≥ 2 type bleeding events using the proposed cutoff value of 33, AUC of 0.676 (<italic>p</italic> = 0.03), and Brier Score of 0.04. The multivariable logistic regression analysis demonstrated that the PRECISE-DAPT score ≥ 33 [OR: 3.772; 95% CI (1.229, 11.578); <italic>p</italic> = 0.02] was associated with BARC ≥ 2 type bleeding event, along with a history of hemorrhagic stroke [OR: 6.806; 95% CI (1.465, 31.613); <italic>p</italic> = 0.014], peptic ulcer [OR: 3.871; 95% CI (1.378, 10.871); <italic>p</italic> = 0.01], and/or myocardial infarction [MI, OR: 3.081; 95% CI (1.140, 8.326); <italic>p</italic> = 0.027].</p><p><bold>Conclusion:</bold> A higher PRECISE-DAPT score of 33 might be a more reasonable cutoff value for predicting BARC ≥2 type bleeding risk in CAD patients (≥75 years). In addition, the history of hemorrhagic stroke, peptic ulcer, and myocardial infarction were identified as the risk factors of BARC ≥2 type bleeding events.</p>