Published online Feb 26, 2022. doi: 10.4330/wjc.v14.i2.96
Peer-review started: May 17, 2021
First decision: July 30, 2021
Revised: August 1, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: February 26, 2022
Processing time: 275 Days and 19.4 Hours
Bleedingsare an independent risk factor for subsequent mortality in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention, representing a hazard equivalent to or greater than that for recurrent ACS. Dual antiplatelet therapy (DAPT) represents the cornerstone in the secondary prevention of thrombotic events, but the benefit of such therapy is counteracted by the increased hemorrhagic complications.
An early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients.
In order to review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease (IHD).
The authors used a combination of terms potentially used in the literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed, as well as references of full-length articles. The authors briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD, focusing on GRACE, CHA2DS2-Vasc, PARIS CTE, DAPT, CRUSADE, ACUITY (Mehran et al), HAS-BLED, PARIS MB and PRECISE-DAPT score.
A single score can’t be the real solution to balance the ischemic/bleeding risk of a patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD. In particular, we found that diabetes mellitus and vascular disease clearly increase the risk of ischemic events, while previous bleeding, anemia and CKD bring a high risk of further bleeding events. Some scores include too many variables that can mislead the clinician’s choice: since a perfect score could not exist we suggest the clinician apply the most user friendly and at the same time evaluate the cited variables separately. As suggested by Guidelines, PRECISE-DAPT could be the most suitable bleeding risk score, since it is more influenced by CKD, anemia and history of bleeding, while PARIS CTE should be the ischemic risk score of choice with diabetes mellitus and vascular disease.
Risk scores by themselves can’t be the single solution to balance the ischemic/bleeding risk of an IHD patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.
Future research should try to elaborate an omni-comprehensive score to be adopted in IHD and at the same time be easy to use and reliable.