- NEWS . 28 Dec 2020
PRECISE-DAPT score useful for bleeding risk stratification in AF patients from RE-DUAL PCI
Patients with atrial fibrillation (AF) undergoing coronary intervention are at increased bleeding risk due to the concomitant need for oral anticoagulation and antiplatelet therapy. In the RE-DUAL PCI trial, a regimen of dual antithrombotic therapy (DAT: dabigatran 110 mg or 150 mg twice daily and clopidogrel or ticagrelor) was shown to have a better safety profile than a triple antithrombotic therapy (TAT: warfarin, clopidogrel or ticagrelor, and aspirin). In this study, researchers sought to explore the impact of baseline bleeding risk based on the PRECISE-DAPT score to help decision-making regarding DAT versus TAT.
A score ≥25 points was considered as high bleeding risk (HBR). Of the 2,725 patients included, PRECISE-DAPT score was available for 2,336, and 37.9% had HBR. Results showed that compared with TAT, DAT with dabigatran 110 mg reduced bleeding risk in both non-HBR (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.31–0.57) and HBR (HR, 0.70; 95% CI, 0.52–0.94), with a greater magnitude of benefit seen in non-HBR. Conversely, TAT reduced bleeding in non-HBR patients (HR, 0.60; 95% CI, 0.45–0.80), with a trend towards less benefit in HBR patients. However, the risk of ischaemic events was similar for DAT with dabigatran (both 110 mg and 150 mg) and TAT in both non-HBR and HBR patients.
The study findings indicated that the PRECISE-DAPT score could be useful to identify AF patients undergoing PCI who are at further increased risk of bleeding complications, as well as to help clinicians select the antithrombotic regimen intensity with the best benefit–risk ratio in this patient population.
Costa F, et al. Antithrombotic therapy according to baseline bleeding risk in patients with atrial fibrillation undergoing percutaneous coronary intervention: applying the PRECISE-DAPT score in RE-DUAL PCI. Eur Heart J Cardiovasc Pharmacother 2020. doi: 10.1093/ehjcvp/pvaa135. [Epub ahead of print].