PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY.

Gragnano, Felice; Heg, Dik; Franzone, Anna; McFadden, Eugène P; Leonardi, Sergio; Piccolo, Raffaele; Vranckx, Pascal; Branca, Mattia; Serruys, Patrick W; Benit, Edouard; Liebetrau, Christoph; Janssens, Luc; Ferrario, Maurizio; Zurakowski, Aleksander; Diletti, Roberto; Dominici, Marcello; Huber, Kurt; Slagboom, Ton; Buszman, Paweł; Bolognese, Leonardo; ... (2020). PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY. (In Press). European heart journal - cardiovascular pharmacotherapy Oxford University Press 10.1093/ehjcvp/pvaa106

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AIMS

The 5-item PRECISE-DAPT, integrating age, haemoglobin, white-blood-cell count, creatinine clearance, and prior bleeding, predicts bleeding risk in patients on dual antiplatelet therapy (DAPT) after stent implantation. We sought to assess whether the bleeding risk prediction offered by the PRECISE-DAPT remains valid among patients receiving ticagrelor monotherapy from 1 month onwards after coronary stenting instead of standard DAPT and having or not having centrally-adjudicated bleeding endpoints.

METHODS AND RESULTS

The PRECISE-DAPT was calculated in 14,928 and 7,134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict BARC 3 or 5 bleeding was assessed and compared among patients on ticagrelor monotherapy (experimental strategy) or standard DAPT (reference strategy) from 1 month after drug-eluting stent implantation. Bleeding endpoints were investigator-reported or centrally-adjudicated in GLOBAL LEADERS and GLASSY, respectively.At 2 years, the c-indexes for the score among patients treated with the experimental or reference strategy were 0.67 (95% confidence interval [CI]:0.63-0.71) vs. 0.63 (95% CI:0.59-0.67) in GLOBAL LEADERS (p = 0.27), and 0.67 (95% CI:0.61-0.73) vs. 0.66 (95% CI:0.61-0.72) in GLASSY (p = 0.88). Decision curve analysis showed net benefit using the PRECISE-DAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified 4-item PRECISE-DAPT.

CONCLUSIONS

The PRECISE-DAPT offers a prediction model that proved similarly effective to predict clinically-relevant bleeding among patients on ticagrelor monotherapy from 1 month after coronary stenting compared with standard DAPT and appears to be unaffected by the presence or absence of adjudicated bleeding endpoints.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Heg, Dierik Hans; Branca, Mattia and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2055-6837

Publisher:

Oxford University Press

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

24 Sep 2020 16:42

Last Modified:

15 Oct 2020 22:39

Publisher DOI:

10.1093/ehjcvp/pvaa106

PubMed ID:

32941620

Uncontrolled Keywords:

Aspirin Bleeding Dual antiplatelet therapy Percutaneous coronary intervention Ticagrelor

BORIS DOI:

10.7892/boris.146626

URI:

https://boris.unibe.ch/id/eprint/146626

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