Login Register Cart 0
Generic placeholder image

Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

The Bleeding Risk in Antithrombotic Therapies: A Narrative Review

Author(s): Adriano Alatri and Lucia Mazzolai*

Volume 18, Issue 3, 2020

Page: [237 - 248] Pages: 12

DOI: 10.2174/1570161117666190212112743

Price: $65

Abstract

Bleeding represents the most important complication of antithrombotic treatment, including anticoagulant and antiplatelet therapies. A number of scores were proposed to evaluate the risk of bleeding both for anticoagulant and antiplatelet treatment. In the last decade, 5 bleeding risk scores were published for use in atrial fibrillation patients, and 3 scores for patients receiving anticoagulants for venous thromboembolism therapy or prophylaxis. In addition, 3 scores were recently developed to assess inhospital or short-term bleeding risk in patients receiving antiplatelet therapy after Acute Coronary Syndrome (ACS) and Percutaneous Coronary Intervention (PCI). Furthermore, 3 additional scores have focused on long-term bleeding in outpatients receiving dual antiplatelet therapy after PCI. The aim of this review is to consider the evidence on bleeding scores.

Keywords: Bleeding, clinical predictive rules, atrial fibrillation, venous thromboembolism, acute coronary syndrome, percutaneous coronary intervention, anticoagulants, antiplatelet therapy.

« Previous Next »
Graphical Abstract

[1]
Schulman S, Kearon C. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3(4): 692-4.
[http://dx.doi.org/10.1111/j.1538-7836.2005.01204.x] [PMID: 15842354]
[2]
Kaatz S, Ahmad D, Spyropoulos AC, Schulman S. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost 2015; 13(11): 2119-26.
[http://dx.doi.org/10.1111/jth.13140] [PMID: 26764429]
[3]
Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123(23): 2736-47.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.110.009449] [PMID: 21670242]
[4]
Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med 1989; 87(2): 144-52.
[http://dx.doi.org/10.1016/S0002-9343(89)80689-8] [PMID: 2787958]
[5]
Beyth RJ, Quinn LM, Landefeld CS. Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med 1998; 105(2): 91-9.
[http://dx.doi.org/10.1016/S0002-9343(98)00198-3] [PMID: 9727814]
[6]
Wells PS, Forgie MA, Simms M, et al. The outpatient bleeding risk index: validation of a tool for predicting bleeding rates in patients treated for deep venous thrombosis and pulmonary embolism. Arch Intern Med 2003; 163(8): 917-20.
[http://dx.doi.org/10.1001/archinte.163.8.917] [PMID: 12719200]
[7]
Aspinall SL, DeSanzo BE, Trilli LE, Good CB. Bleeding Risk Index in an anticoagulation clinic. Assessment by indication and implications for care. J Gen Intern Med 2005; 20(11): 1008-13.
[http://dx.doi.org/10.1111/j.1525-1497.2005.0229.x] [PMID: 16307625]
[8]
Kuijer PM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 1999; 159(5): 457-60.
[http://dx.doi.org/10.1001/archinte.159.5.457] [PMID: 10074953]
[9]
Kearon C, Ginsberg JS, Kovacs MJ, et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003; 349(7): 631-9.
[http://dx.doi.org/10.1056/NEJMoa035422] [PMID: 12917299]
[10]
Shireman TI, Mahnken JD, Howard PA, Kresowik TF, Hou Q, Ellerbeck EF. Development of a contemporary bleeding risk model for elderly warfarin recipients. Chest 2006; 130(5): 1390-6.
[http://dx.doi.org/10.1378/chest.130.5.1390] [PMID: 17099015]
[11]
Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J 2006; 151(3): 713-9.
[http://dx.doi.org/10.1016/j.ahj.2005.04.017] [PMID: 16504638]
[12]
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138(5): 1093-100.
[http://dx.doi.org/10.1378/chest.10-0134] [PMID: 20299623]
[13]
Fang MC, Go AS, Chang Y, et al. A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol 2011; 58(4): 395-401.
[http://dx.doi.org/10.1016/j.jacc.2011.03.031] [PMID: 21757117]
[14]
O’Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J 2015; 36(46): 3258-64.
[http://dx.doi.org/10.1093/eurheartj/ehv476] [PMID: 26424865]
[15]
Hijazi Z, Oldgren J, Lindbäck J, et al. The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet 2016; 387(10035): 2302-11.
[http://dx.doi.org/10.1016/S0140-6736(16)00741-8] [PMID: 27056738]
[16]
Ruíz-Giménez N, Suárez C, González R, et al. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100(1): 26-31.
[http://dx.doi.org/10.1160/TH08-03-0193] [PMID: 18612534]
[17]
Nieto JA, Solano R, Ruiz-Ribó MD, et al. Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry. J Thromb Haemost 2010; 8(6): 1216-22.
[http://dx.doi.org/10.1111/j.1538-7836.2010.03852.x] [PMID: 20345727]
[18]
Decousus H, Tapson VF, Bergmann JF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 2011; 139(1): 69-79.
[http://dx.doi.org/10.1378/chest.09-3081] [PMID: 20453069]
[19]
Olesen JB, Lip GY, Hansen PR, et al. Bleeding risk in ‘real world’ patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort. J Thromb Haemost 2011; 9(8): 1460-7.
[http://dx.doi.org/10.1111/j.1538-7836.2011.04378.x] [PMID: 21624047]
[20]
Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33(12): 1500-10.
[http://dx.doi.org/10.1093/eurheartj/ehr488] [PMID: 22246443]
[21]
Gallego P, Roldán V, Torregrosa JM, et al. Relation of the HAS-BLED bleeding risk score to major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2012; 5(2): 312-8.
[http://dx.doi.org/10.1161/CIRCEP.111.967000] [PMID: 22319005]
[22]
Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011; 57(2): 173-80.
[http://dx.doi.org/10.1016/j.jacc.2010.09.024] [PMID: 21111555]
[23]
Apostolakis S, Lane DA, Guo Y, Buller H, Lip GY. Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study. J Am Coll Cardiol 2012; 60(9): 861-7.
[http://dx.doi.org/10.1016/j.jacc.2012.06.019] [PMID: 22858389]
[24]
Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365(10): 883-91.
[http://dx.doi.org/10.1056/NEJMoa1009638] [PMID: 21830957]
[25]
Senoo K, Proietti M, Lane DA, Lip GY. Evaluation of the HAS-BLED, ATRIA, and ORBIT bleeding risk scores in patients with atrial fibrillation taking warfarin. Am J Med 2016; 129(6): 600-7.
[http://dx.doi.org/10.1016/j.amjmed.2015.10.001] [PMID: 26482233]
[26]
Caldeira D, Costa J, Fernandes RM, Pinto FJ, Ferreira JJ. Performance of the HAS-BLED high bleeding-risk category, compared to ATRIA and HEMORR2HAGES in patients with atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2014; 40(3): 277-84.
[http://dx.doi.org/10.1007/s10840-014-9930-y] [PMID: 25012972]
[27]
Zhu W, He W, Guo L, Wang X, Hong K. the has-bled score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis. Clin Cardiol 2015; 38(9): 555-61.
[http://dx.doi.org/10.1002/clc.22435] [PMID: 26418409]
[28]
Fauchier L, Chaize G, Gaudin A-F, Vainchtock A, Rushton-Smith SK, Cotté FE. Predictive ability of HAS-BLED, HEMORR2HAGES, and ATRIA bleeding risk scores in patients with atrial fibrillation. A French nationwide cross-sectional study. Int J Cardiol 2016; 217: 85-91.
[http://dx.doi.org/10.1016/j.ijcard.2016.04.173] [PMID: 27179213]
[29]
Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365(11): 981-92.
[http://dx.doi.org/10.1056/NEJMoa1107039] [PMID: 21870978]
[30]
Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361(12): 1139-51.
[http://dx.doi.org/10.1056/NEJMoa0905561] [PMID: 19717844]
[31]
Zulkifly H, Lip GYH, Lane DA. bleeding risk scores in atrial fibrillation and venous thromboembolism. Am J Cardiol 2017; 120(7): 1139-45.
[http://dx.doi.org/10.1016/j.amjcard.2017.06.058] [PMID: 28800833]
[32]
Esteve-Pastor MA, Rivera-Caravaca JM, Roldan V, et al. Long-term bleeding risk prediction in ‘real world’ patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project. Thromb Haemost 2017; 117(10): 1848-58.
[http://dx.doi.org/10.1160/TH17-07-0478] [PMID: 28799620]
[33]
Nieto JA, Solano R, Trapero Iglesias N, et al. Validation of a score for predicting fatal bleeding in patients receiving anticoagulation for venous thromboembolism. Thromb Res 2013; 132(2): 175-9.
[http://dx.doi.org/10.1016/j.thromres.2013.06.019] [PMID: 23849097]
[34]
Hostler DC, Marx ES, Moores LK, et al. Validation of the international medical prevention registry on venous thromboembolism bleeding risk score. Chest 2016; 149(2): 372-9.
[http://dx.doi.org/10.1378/chest.14-2842] [PMID: 26867833]
[35]
Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006; 114(8): 774-82.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.106.612812] [PMID: 16908769]
[36]
Manoukian SV, Feit F, Mehran R, et al. Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes: an analysis from the ACUITY Trial. J Am Coll Cardiol 2007; 49(12): 1362-8.
[http://dx.doi.org/10.1016/j.jacc.2007.02.027] [PMID: 17394970]
[37]
Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 2009; 119(14): 1873-82.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.828541] [PMID: 19332461]
[38]
Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol 2010; 55(23): 2556-66.
[http://dx.doi.org/10.1016/j.jacc.2009.09.076] [PMID: 20513595]
[39]
Mathews R, Peterson ED, Chen AY, et al. In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care: derivation and validation of a model from the ACTION Registry®-GWTG™. Am J Cardiol 2011; 107(8): 1136-43.
[http://dx.doi.org/10.1016/j.amjcard.2010.12.009] [PMID: 21324428]
[40]
Yeh RW, Secemsky EA, Kereiakes DJ, et al. development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 2016; 315(16): 1735-49.
[http://dx.doi.org/10.1001/jama.2016.3775] [PMID: 27022822]
[41]
Baber U, Mehran R, Giustino G, et al. Coronary thrombosis and major bleeding after pci with drug-eluting stents: risk scores from paris. J Am Coll Cardiol 2016; 67(19): 2224-34.
[http://dx.doi.org/10.1016/j.jacc.2016.02.064] [PMID: 27079334]
[42]
Costa F, van Klaveren D, James S, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 2017; 389(10073): 1025-34.
[http://dx.doi.org/10.1016/S0140-6736(17)30397-5] [PMID: 28290994]
[43]
Abu-Assi E, Gracía-Acuña JM, Ferreira-González I, Peña-Gil C, Gayoso-Diz P, González-Juanatey JR. Evaluating the performance of the can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA Guidelines (CRUSADE) bleeding score in a contemporary Spanish cohort of patients with non-ST-segment elevation acute myocardial infarction. Circulation 2010; 121(22): 2419-26.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.925594] [PMID: 20497978]
[44]
Stone GW, Bertrand M, Colombo A, et al. Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. Am Heart J 2004; 148(5): 764-75.
[http://dx.doi.org/10.1016/j.ahj.2004.04.036] [PMID: 15523305]
[45]
Mehran R, Brodie B, Cox DA, et al. The harmonizing outcomes with revascularization and stents in acute myocardial infarction (HORIZONS-AMI) Trial: study design and rationale. Am Heart J 2008; 156(1): 44-56.
[http://dx.doi.org/10.1016/j.ahj.2008.02.008] [PMID: 18585496]
[46]
Desai NR, Kennedy KF, Cohen DJ, et al. Contemporary risk model for inhospital major bleeding for patients with acute myocardial infarction: The acute coronary treatment and intervention outcomes network (ACTION) registry®-Get With The Guidelines (GWTG)®. Am Heart J 2017; 194: 16-24.
[http://dx.doi.org/10.1016/j.ahj.2017.08.004] [PMID: 29223432]
[47]
Flores-Ríos X, Couto-Mallón D, Rodríguez-Garrido J, et al. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients. Eur Heart J Acute Cardiovasc Care 2013; 2(1): 19-26.
[http://dx.doi.org/10.1177/2048872612469885] [PMID: 24062930]
[48]
Liu R, Lyu SZ, Zhao GQ, et al. Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding scores in ACS patients undergoing PCI: insights from a cohort of 4939 patients in China. J Geriatr Cardiol 2017; 14(2): 93-9.
[PMID: 28491083]
[49]
Xi S, Zhou S, Wang X, et al. The Performance of CRUSADE and ACUITY bleeding risk scores in ticagrelor-treated ACS patients who underwent PCI. Thromb Haemost 2017; 117(11): 2186-93.
[http://dx.doi.org/10.1160/TH17-04-0237] [PMID: 29044298]
[50]
Bittl JA, Baber U, Bradley SM, Wijeysundera DN. duration of dual antiplatelet therapy: a systematic review for the 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol 2016; 68(10): 1116-39.
[http://dx.doi.org/10.1016/j.jacc.2016.03.512] [PMID: 27036919]
[51]
Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American college of cardiology/American heart association task force on clinical practice guidelines. J Am Coll Cardiol 2016; 68(10): 1082-115.
[http://dx.doi.org/10.1016/j.jacc.2016.03.513] [PMID: 27036918]
[52]
Valgimigli M, Bueno H, Byrne RA, et al. ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The task force for dual antiplatelet therapy in coronary artery disease of the European society of cardiology (ESC) and of the European association for cardio-thoracic surgery (EACTS). Eur Heart J 2018; 39(3): 213-60.
[http://dx.doi.org/10.1093/eurheartj/ehx419] [PMID: 28886622]
[53]
Costa F, Tijssen JG, Ariotti S, et al. Incremental Value of the CRUSADE, ACUITY, and HAS-BLED risk scores for the prediction of hemorrhagic events after coronary stent implantation in patients undergoing long or short duration of dual antiplatelet therapy. J Am Heart Assoc 2015; 4 pii: e002524
[http://dx.doi.org/10.1161/JAHA.115.002524] [PMID: 26643501]
[54]
Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-962.
[http://dx.doi.org/10.1093/eurheartj/ehw210] [PMID: 27567408]

Rights & Permissions Print Cite
Article Metrics
37
2
© 2024 Bentham Science Publishers | Privacy Policy