Novedades en la evaluación del riesgo hemorrágico del paciente con cardiopatía isquémica

The assessment of bleeding risk is the limiting factor in determining the balance between the risk of ischemia and hemorrhage, which must be determined before the type and duration of antithrombotic therapy can be selected. The best data for estimating bleeding risk are available during hospitalization and several suitable risk scores have been developed and have undergone extensive validation and comparison. The CRUSADE bleeding score appears to be the most useful. In addition, several risk scores for assessing bleeding risk over the medium to long term after hospital discharge or after coronary artery revascularization have recently appeared, such as the PRECISE-DAPT (PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy), the PARIS (Patterns of non-Adherence to Anti-Platelet Regimens in Stented Patients), the DAPT (Dual AntiPlatelet Therapy) and the TRILOGY-ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) risk scores. All have demonstrated reasonably good predictive power but they have some important limitations, which mean that they will have to undergo comparative validation studies before their usefulness can be extended to patients treated with new antiplatelet agents (e.g. ticagrelor and prasugrel) and oral anticoagulants, including both vitamin K antagonists and direct-acting oral anticoagulants.