Abstract 18785: Should We Recommend Triple Therapy for Patients Undergoing Stent Implantation With a High Score HAS-BLED?
Introduction: Current clinical guidelines recommend the use of HAS-BLED score to assess the risk of bleeding in patients requiring oral anticoagulation (OAC) undergoing percutaneous coronary intervention with stenting (PCI-S).
Hypothesis: The use of OAC in patients requiring OAC with a high score HAS-BLED would be not safe.
Objective: To evaluate the safety of OAC in patients with indication and a high risk of bleeding (HAS-BLED score ≥ 3) who undergoing PCI-s.
Methods: A prospective multicenter study was conducted from 2007 to 2012 to identify patients requiring long-term OAC undergoing PCI-S. All adverse outcomes were analyzed at 1-year follow-up.
Results: We identified 828 patients requiring OAC (77.3% male, 72.0±9.3 years) undergoing PCI-S. Five-hundred thirteen (62%) had a HAS-BLED ≥ 3. Of these, 329 (64.8%) received OAC. These patients had a mortality rate (10.1% vs. 10.3%) and major adverse cardiac events rate (MACE) (19.6% vs. 18.8%, p=0:46) similar to those who did not receive OAC. However, bleeding events rate was significantly higher (15.1% vs. 23.7%, p=0.01) with an excess of major bleeding (3.4% vs. 9.2%, p=0.01) in patients treated on OAC. In a multivariate analysis, in patients with a HAS-BLED ≥ 3: age (p=0.02) and renal failure (p <0.001) were predictors of mortality, but OAC was not associated with mortality. The only predictor of bleeding events was the use of OAC (p=0.01), while renal failure and use of drug eluting stents were not.
Conclusions: A high percentage of patients undergoing PCI-S have a high bleeding risk (HAS-BLED ≥ 3). In these patients, the use of OAC does not seem to improve prognosis, but increases the incidence of major bleeding.
Author Disclosures: A. Sambola: None.
- © 2014 by American Heart Association, Inc.