A new scoring system aims to predict the risk for major bleeding in patients following transient ischemic attack or ischemic stroke.
“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, a PhD student at 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.”
The researchers, who published their findings in Neurology, sought to develop and externally validate a model designed to predict three-year risk for major bleeding in patients who use antiplatelet therapy after transient ischemic attack or stroke.
Major bleeding occurred in 1,530 of 43,112 patients in the study population. Hilkens and colleagues identified the following characteristics as risk factors for major bleeding: male sex, smoking, type of antiplatelet agents, high stroke disability score, prior stroke, high blood pressure, lower body mass index, old age, Asian ethnicity and diabetes.
The risk for bleeding ranged from 2 percent in patients age 45 to 54 to more than 10 percent in individuals age 75 to 84 with multiple risk factors.
After external validation, the authors noted their model—called the S2TOP-BLEED score—slightly underestimated major bleeding risk.
In an accompanying editorial, Robin Lemmens of Leuven University in Belgium wrote neuroimaging measures might improve the model’s accuracy.
“The authors are to be congratulated for developing a well-executed and externally validated major bleeding risk score for patients with a probable non-cardio-embolic TIA or ischemic stroke treated with antiplatelet therapy, although the discrimination of the S2TOP-BLEED score currently limits its utility in clinical practice,” Lemmens wrote. “The score could be refined in future studies, potentially with a focus on predictors of intracranial bleeding, the most devastating complication of antithrombotic therapies.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.