Factors Identified for Bleeding Risk in ACS Patients on DAPT

August 14, 2017

Researchers have determined 10 baseline predictors for severe bleeding risk as defined by the Global Use of Strategies to Open Occluded Arteries (GUSTO) model and 5 predictors of major bleeding as defined by the Thrombolysis In Myocardial Infarction (TIMI) model in patients receiving dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS).

Although treatment recommendations for patients with ACS include DAPT with aspirin plus a P2Y12 inhibitor for at least 12 months, no tools are currently available to predict an individual’s bleeding risk while receiving DAPT following ACS. Therefore, the researchers used the GUSTO and TIMI models to better understand the predictors of long-term bleeding risk in this population.

Is Low-Dose Rivaroxaban Safe for Patients with Acute Coronary Syndromes?
Initiative Aims to Combat Hospitalizations After Acute Coronary Syndrome Events

The researchers evaluated 9240 patients with unstable angina and/or non-ST segment elevation myocardial infarction (NSTEMI) enrolled in the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial. All patients were managed without revascularization and had received DAPT for a median of 14.8 months.

Overall, the researchers determined 10 significant baseline predictors of non-coronary artery bypass grafting-related severe, life-threatening, and/or moderate bleeding as defined by GUSTO: age, sex, weight, NSTEMI, angiography performed prior to randomization, history of peptic ulcer disease, creatinine level, systolic blood pressure, hemoglobin level, and treatment with β-blockers.

The researchers also found 5 significant baseline predictors of major or minor bleeding as defined by TIMI: age, sex, angiography performed prior to randomization, and creatinine and hemoglobin levels.

Both the GUSTO and TIMI models demonstrated good predictive accuracy with Therneau’s C-indices.

“Longitudinal bleeding risks during treatment with DAPT in patients with ACS can be reliably predicted using selected baseline characteristics,” the researchers concluded. “The TRILOGY ACS bleeding models can inform risk-benefit considerations regarding the duration of DAPT following ACS.”

—Christina Vogt


Alfredsson J, Neely B, Neely ML, et al; TRILOGY ACS Investigators. Predicting the risk of bleeding during dual antiplatelet therapy after acute coronary syndromes. Heart. 2017;103(15):1168-1176. doi:10.1136/heartjnl-2016-310090.