Background: Antiplatelets are widely prescribed in medical patients, both for primary and secondary prevention of cardiovascular diseases and they may increase the patient’s bleeding risk. At present, no appropriate tools are available for hemorrhagic risk assessment in this population.

Aims: In a large cohort of medical patients, we aimed to define the incidence of antiplatelets-related hemorrhage, identify clinical features associated with bleeding and develop a simple score able to predict them.

Methods: Medical patients were considered eligible for this cohort study, provided they were taking antiplatelets and weren’t on anticoagulant treatment. In a 12-months follow-up, we calculated the incidence of bleeding and identified factors independently associated with bleeding. We then developed a bedside risk score including the most predictive risk factors, weighted according to their strength of association with the bleeding complication.

Results: We enrolled 1275 patients; mean age was 75,3±13,6 years. In a 1-year follow-up, 164 (12.9%) major/non-major clinically relevant (NMCR) bleeds occurred, while the incidence of minor bleeding was 14.6%. Gastrointestinal tract was the most frequent site of bleeding (87% composite of
major/NMCR and minor bleeding). Clinical features associated with bleeding at the univariate analysis (p>0.020) were tested in a logistic regression model. Female sex, history of anemia/previous bleeding, gastrointestinal tract disease, frequent falls/loss of consciousness and severe renal impairment have been found as independent risk factors for bleeding in antiplatelets-treated patients. These features have been associated in a five-item score that reached specificity 71%, sensibility 91% and AUC 0.80 (95%CI 0.71–0.94) in the derivation cohort (Fig.1). Compared with low-risk participants, high-risk participants had an 8-fold greater risk of bleeding (HR 7.91; 95%CI 5.63-11.1).

The newly derived score and its ROC curve in the derivation cohort

Conclusions: Despite their bleeding risk, antiplatelets are broadly prescribed in medical patients. A new simple score may be helpful in predicting individual hemorrhagic risk in antiplatelets-treated patients. Further studies are needed to confirm these findings.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-simple-score-to-evaluate-bleeding-risk-in-medical-patients-taking-antiplatelets-for-cardiovascular-prevention/