Assessment of bleeding risk in patients with coronary artery disease on dual antiplatelet therapy A systematic review
Autor: | Yvonne M. C. Henskens, Minka J A Vries, ten Cate-Hoek Aj, van der Meijden Pe, ten Cate H |
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Přispěvatelé: | Biochemie, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, Promovendi CD, RS: CARIM - R1.03 - Cell biochemistry of thrombosis and haemostasis, Med Microbiol, Infect Dis & Infect Prev, MUMC+: DA CDL Algemeen (9), MUMC+: MA Alg Interne Geneeskunde (9), Interne Geneeskunde |
Jazyk: | angličtina |
Rok vydání: | 2016 |
Předmět: |
medicine.medical_specialty
Genotype Platelet Function Tests medicine.medical_treatment Drug Resistance Hemorrhage CYP2C19 030204 cardiovascular system & hematology Risk Assessment Decision Support Techniques Coronary artery disease 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Predictive Value of Tests Risk Factors Internal medicine medicine Humans 030212 general & internal medicine business.industry Incidence (epidemiology) Percutaneous coronary intervention Hematology medicine.disease bleeding prognostic tests Surgery Cytochrome P-450 CYP2C19 Treatment Outcome Pharmacogenetics Predictive value of tests Dual antiplatelet therapy Critical Pathways Platelet aggregation inhibitor Drug Therapy Combination Risk assessment business Algorithms Platelet Aggregation Inhibitors coronary artery disease |
Zdroj: | Thrombosis and Haemostasis, 115(1), 7-24. Georg Thieme Verlag |
ISSN: | 0340-6245 |
Popis: | SummaryPatients 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. |
Databáze: | OpenAIRE |
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