Bianca Rocca: PRECISE-DAPT Score Identifies Bleeding Risk After CABG in Patients With POAF
Bianca Rocca, Editor in Chief at European Heart Journal Cardiovascular Pharmacotherapy, shared on X about a recent article by Mary Rezk et al, published in European Heart Journal – Cardiovascular Pharmacotherapy, adding:
” New in EHJ – CVP
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Bleeding risk assessment in patients with new-onset atrial fibrillation after coronary surgery: a proof-of-concept study
Is a bleeding risk score able to identify which patients with post-operative AF after CABG are most likely to bleed after discharge?
Guidelines recommend weighing bleeding risk before starting anticoagulation, but none clearly define how to measure it.
The nationwide Swedish registry cohort included 4,436 patients with POAF after first-time isolated CABG (2009 to 2020) who did not receive oral anticoagulation at discharge, mirroring the therapeutic dilemma a clinician faces at discharge.
The four-item PRECISE-DAPT score (age, creatinine clearance, preoperative haemoglobin, previous bleeding) classified 36% of the patients as high risk.
Major bleeding during the first year occurred in 0.8% of low-risk, 1.9% of moderate-risk and 3.6% of high-risk patients, with a hazard ratio of 4.81 (95% CI 2.59 to 8.96) for high versus low risk.Discrimination was moderate (AUC 0.68) and calibration was good up to a predicted annual risk of about 7%.
This is an observational registry study. Patients on anticoagulation were excluded, so the findings apply to those judged safe to discharge without it, and registry-based definitions will miss bleeds that did not lead to hospitalisation. The score separates risk groups, but whether using it to guide anticoagulation improves outcomes will need prospective, randomized testing.”
Title: Bleeding risk assessment in patients with new-onset atrial fibrillation after coronary surgery: a proof-of-concept study
Authors: Mary Rezk, Amar Taha, Andreas Martinsson, Susanne J Nielsen, Tomas Gudbjartsson, Lennart Bergfeldt, Florian E M Herrmann, Emma C Hansson, Anders Jeppsson
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