Key result
High PRECISE-DAPT score is linked to ~4.8-fold higher 1-year major bleeding risk after CABG.
Why the study?
Guidelines recommend balancing stroke and bleeding risk when considering long-term oral anticoagulation for POAF after cardiac surgery, but provide no specific approach to bleeding risk assessment.
Can the PRECISE-DAPT bleeding risk score stratify the 1-year post-discharge major bleeding risk in patients with new-onset post-operative atrial fibrillation after CABG?
Cohort (n=4,436)
Yes
Can the PRECISE-DAPT bleeding risk score stratify the 1-year post-discharge major bleeding risk in patients with new-onset post-operative atrial fibrillation after CABG?
The PRECISE-DAPT score can stratify patients with new-onset postoperative atrial fibrillation after CABG into distinct groups based on their 1-year major bleeding risk, demonstrating moderate discrimination.
May aid bleeding risk assessment in post-CABG AF; leaves open whether score-guided decisions improve outcomes.
AIMS: Current guidelines recommend considering long-term oral anticoagulation in patients with new-onset postoperative atrial fibrillation (POAF) after cardiac surgery, balancing stroke and bleeding risk. However, no specific approach to bleeding risk assessment is provided. We explored in a proof-of-concept study whether a bleeding risk score can identify patients with POAF after coronary artery bypass grafting (CABG) with increased risk of post-discharge major bleeding. METHODS AND RESULTS: This observational cohort study included 4436 patients with POAF after CABG in 2009-2020 without oral anticoagulation. The four-item PRECISE-DAPT score (based on age, creatinine clearance, preoperative hemoglobin concentration, and previous bleeding) was calculated for all patients. Bleeding risk was defined as high (≥25 points), medium (16-24 points), or low (≤15 points). Associations between bleeding risk and major bleeding events during the first postoperative year were assessed by Cox regression. Discrimination was evaluated with C-statistics, and calibration by comparing expected and observed bleeding rates. Major bleeding occurred in 2.1% of patients during the first year. The score classified 36.0% of patients as high bleeding risk. The hazard ratio for high versus low bleeding risk was 4.81 (95% CI 2.59-8.96). The area under the receiver operating characteristic curve was 0.68 (95% CI 0.63-0.73). Calibration showed good agreement between expected and observed bleeding events in patients with an annual bleeding risk up to 7%. CONCLUSIONS: A bleeding risk score can be used to stratify patients with POAF after CABG into groups with different post-discharge bleeding risk. Further studies are necessary to identify the optimal risk score and its role in OAC decision pathway to improve clinical outcomes.
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Rezk et al. (2026) conducted a cohort in New-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) (n=4,436). High bleeding risk (PRECISE-DAPT score ≥25 points) vs. Low bleeding risk (PRECISE-DAPT score ≤15 points) was evaluated on Post-discharge major bleeding during the first 12 post-operative months (HR 4.81, 95% CI 2.59-8.96, p=<0.001). Classification as high bleeding risk by the PRECISE-DAPT score identified patients with a significantly increased risk of major bleeding during the first year after CABG (HR 4.81 vs low risk) with moderate discrimination (AUC 0.68).
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