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
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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