NEW research highlights the utility of the PRECISE-DAPT score in predicting gastrointestinal (GI) bleeding risk in patients undergoing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI).
The retrospective analysis, conducted from 2014–2021, included 1,067 patients treated for acute coronary syndrome (ACS), focusing on bleeding incidence and risk stratification (mean age 62.3 years, 66.6% male, 77.1% Hispanic). Among the patients, 57.9% received clopidogrel, while 42% were treated with ticagrelor.
Over a median follow-up of 2.2 years (interquartile range: 0.2–4.2), the 1-year GI bleeding rate was 2.5%, increasing to 3.6% for the entire study period. Bleeding locations were distributed as follows: lower GI bleeding accounted for 44%, upper GI bleeding 31%, small bowel bleeding 10%, and 15% of cases had undetermined causes. Colon cancer emerged as the most frequent aetiology, responsible for 18% of bleeding events.
The study also analysed bleeding risk associated with different antiplatelet therapies. No significant difference was observed in GI bleeding incidence between clopidogrel and ticagrelor groups, with bleeding rates of 21.2% and 19.2%, respectively (hazard ratio: 0.6, 95% CI: 0.3–1.3, P=0.2).
The PRECISE-DAPT score effectively stratified patients into low (≤17), moderate (18–24), and high-risk (≥25) categories for GI bleeding. Patients in moderate and high-risk groups were significantly more likely to experience bleeding compared to the low-risk group. The odds ratio for bleeding was 2.8 (95% CI: 1.1–7.2) in the moderate-risk group and 2.5 (95% CI: 1.0–6.0) in the high-risk group.
These findings confirm the utility of the PRECISE-DAPT score in assessing GI bleeding risk in post-PCI patients. The results suggest that high-risk patients may benefit from targeted monitoring and potentially earlier GI screening to mitigate bleeding complications while maintaining thrombotic protection.
Reference
Guzman JA et al. Gastrointestinal bleeding in post-PCI patients on antiplatelet therapy and the predictive value of the PRECISE-DAPT score. S951. ACG Annual Meeting 2024, 25-30 October, 2024.
