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New method may identify patients at risk for bleeding after stroke

A novel scoring model may help predict the risk for major bleeding in patients who use antiplatelet agents after transient ischemic attack or ischemic stroke, according to findings published in Neurology.

“Prediction of bleeding risk based on patient characteristics may help physicians to balance benefits and risks of antiplatelet therapy for individual patients,” Nina A. Hilkens, MD, from the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht in the Netherlands, and colleagues wrote. “A recent systematic review showed that a limited number of prediction models are available for prediction of bleeding in patients on antiplatelet therapy for secondary prevention.”

Researchers sought to create and externally validate a model that can predict the 3-year risk for major bleeding in patients who use antiplatelet agents following transient ischemic attack or ischemic stroke. Using data from six randomized clinical trials that assessed antiplatelet therapy after stroke, they analyzed the association between predictors and major bleeding. They used the PERFORM trial, a clinical study that examined 18,417 patients with recent transient ischemic attack or ischemic stroke randomly assigned to receive terutroban or aspirin, to develop and validate their risk prediction score model.

Major bleeding occurred in 1,530 of 43,112 participants. Analysis showed that the 3-year risk of major bleeding in patients who use antiplatelet agents after stroke was 4.6% (95% CI, 4.4-4.8). Hilkens and colleagues found that the characteristics that helped predict the risk for bleeding included male sex, smoking, type of antiplatelet agents, high stroke disability score, prior stroke, high BP, lower BMI, old age, Asian ethnicity and diabetes. In total, 23,678 participants were scored as low risk for major bleeding, 16,621 were scored as medium risk and 2,813 were scored as high risk. The risk for bleeding ranged from 2% in patients aged 45 to 54 years with no additional risk factors to more than 10% in those aged 75 to 84 years with multiple risk factors.

“The increasing risk of bleeding with older age seems particularly important given the rising number of elderly people with a stroke or [transient ischemic attack], with around 30% of strokes occurring in people over 80,” Hilkens said in a press release. “While the model may help identify people at high risk of major bleeding, it does not aim to guide treatment choices for antiplatelet drugs, as the risk of bleeding should always be balanced against the risk of recurrent stroke.” – by Savannah Demko

Disclosure: Hilkens reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.