Perceived or Calculated Bleeding Risk and Their Relation With Dual Antiplatelet Therapy Duration in Patients Undergoing Percutaneous Coronary Intervention

artery disease ◼ hemorrhage ◼ percutaneous coronary intervention ◼ prasugrel hydrochloride ◼ ticagrelor I schemic and bleeding risk are overestimated by physicians in patients at low risk and are underestimated in those at high risk from such complications. 1 Risk stratification scores provide superior discrimination of future ischemic events compared with that estimated by physicians only in very high-risk patients; conversely, bleeding risk evaluation appears poor either when objectively calculated or perceived by clinicians. 1 A short duration of dual antiplatelet therapy (SDAPT) is associated with a reduction in bleeding complications, but is less protective from ischemic events. 2 The use of risk scores may be useful for risk assessment, and guiding SDAPT, both for stable coronary artery disease and acute coronary syndromes (ACS), and should be considered in patients at high bleeding risk.3 We aimed to compare in patients undergoing percutaneous coronary intervention the bleeding risk at hospital discharge as perceived by the treating physician with that calculated using 4 different bleeding risk stratification scores; furthermore, we investigated the influence of the perceived and calculated high bleeding risk on the prescription of a SDAPT and only for patients with ACS, on the choice of the P2Y12 inhibitor (clopidogrel versus prasugrel or ticagrelor).The Post-PCI registry is a multicenter, observational, prospective data collection performed at 31 Italian hospitals during a 4-week period (March 15th-April 15th, 2017) that included consecutive patients undergoing percutaneous coronary intervention, both for stable coronary artery disease or ACS.The registry was approved by the local ethical committee of all participating hospitals, and written informed consent was obtained before entry into the study.All decisions about medical treatment and interventional procedures were left at discretion of the treating physicians who were asked to report their perceived risk of bleeding at hospital discharge as low, moderate, or high.Then, blindly, CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early implementation), PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients), ACUITY-HORIZON (Acute Catheterization and Urgent Intervention Triage Strategy-Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction), and PRECISE-DAPT (Predicting Bleeding Complication in PatientsUndergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) bleeding scores were calculated.For the analysis, all the scores were categorized in 2 groups: low/moderate versus high.SDAPT was considered when therapy duration was prescribed for <6 months in patients with stable coronary artery disease and for <12 months in patients with ACS.The data that support the findings of this study are available from the corresponding author on request.Associations were evaluated by Pearson χ 2 test or Fisher exact test and correlations by Pearson coefficient.Multivariable analysis was performed using binary logistic regression models, including all variables significantly associated with clopidogrel use.