Validation of high bleeding risk criteria and definition as proposed by the academic research consortium for high bleeding risk

Abstract

Aims To validate the set of clinical and biochemical criteria proposed by consensus by the Academic Research Consortium (ARC) for High Bleeding Risk (HBR) for the identification of HBR patients. These criteria were categorized into major and minor, if expected to carry in isolation, respectively, ≥4% and <4% Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding risk within 1-year after percutaneous coronary intervention (PCI). High bleeding risk patients are those meeting at least 1 major or 2 minor criteria. Methods and results All patients undergoing PCI at Bern University Hospital, between February 2009 and September 2018 were prospectively entered into the Bern PCI Registry (NCT02241291). Age, haemoglobin, platelet count, creatinine, and use of oral anticoagulation were prospectively collected, while the remaining HBR criteria except for planned surgery were retrospectively adjudicated. A total of 16 580 participants with complete ARC-HBR criteria were included. After assigning 1 point to each major and 0.5 point to each minor criterion, we observed for every 0.5 score increase a step-wise augmentation of BARC 3 or 5 bleeding rates at 1 year ranging from 1.90% among patients fulfilling no criterion, through 4.01%, 5.98%, 7.42%, 8.60%, 12.21%, 12.29%, and 17.64%. All major and five out of six minor criteria, conferred in isolation a risk for BARC 3 or 5 bleeding at 1 year exceeding 4% at the upper limit of the 95% confidence intervals. Conclusion All major and the majority of minor ARC-HBR criteria identify in isolation patients at HBR.

Academic Research Consortium Definition of High Bleeding Risk in Clinical Practice ― Validation and Beyond ―

“…Notably, HBR in that study was determined retrospectively using the original ARC-HBR criteria, despite the potential for underestimation. Because only 1 study has evaluated the discriminative accuracy of the complete ARC-HBR criteria so far (Table ), 5 this is an important point. At 1 year, patients with HBR had an increased risk of major bleeding (BARC 3 or 5) than those without HBR (3.6% vs. 0.5%; P<0.001).…”

Development and validation of a risk prediction nomogram for in-stent restenosis in patients undergoing percutaneous coronary intervention

“…The ARC-HBR score is a criterion used for identifying PCI patients with high risk of bleeding events. Risk factors in this criterion includes age, oral anticoagulation, chronic kidney disease, hemoglobin, prior bleeding, thrombocytopenia, chronic bleeding diathesis, liver cirrhosis with portal hypertension, use of NSAIDs or Steroids, active malignancy, prior stroke, and surgery or trauma within 30 days [ 18 ]. The PRECISE-DAPT score was also a model to predict bleeding risks for patients after coronary stenting [ 19 ], which was based on five factors: integrating age, hemoglobin, white-blood-cell count, creatinine clearance, and prior bleeding.…”

Effect of aspirin treatment duration on clinical outcomes in acute coronary syndrome patients with early aspirin discontinuation and received P2Y12 inhibitor monotherapy

“…Recently, the Academic Research Consortium (ARC) for High Bleeding Risk (HBR) criteria were proposed and validated to identify patients with bleeding risk [30][31][32]. The rate of BARC 3 or 5 bleeding at 1 year was 3.6% in our cohort which can be defined as borderline HBR according to the 4% cut-off proposed by the ARC-HBR to identify HBR patients [31,32]. Among the studies of P2Y12 inhibitor monotherapy, the SMART-CHOICE, STOPDAPT-2 and TICO trials were performed in East Asian countries.…”