title: Utility of the HAS-BLED Score in Risk Stratifying Patients on Dual Antiplatelet Therapy Post 12 Months After Drug-Eluting Stent Placement.
abstract: BACKGROUND
  Current guidelines recommend continuation of dual anti-platelet therapy (DAPT) for 12 months after percutaneous coronary intervention (PCI). Recent studies have shown benefit in continuing DAPT beyond 12 months but at the risk of increase bleeding. To date, there has been little data on risk stratifying patients to determine who can continue DAPT beyond 12 months at minimal bleeding risk.
  
  
  METHODS
  All patients who underwent drug-eluting stent (DES) placement from January 1, 2013 to September 30, 2014 were reviewed. Patients who had follow-up for at least 12 months, placement of 2nd generation everolimus-coated DES, and were on DAPT for at least 12 months were included. Patients with a history of atrial fibrillation, follow-up time less than 12 months, or were on concurrent oral anticoagulation therapy were excluded.
  
  
  RESULTS
  Five hundred thirty-one patients were analyzed as described above. Two hundred two patients included in our study with 7 patients in the bleeding cohort and 195 patients in no-bleed cohort. The HAS-BLED score in patients who had a bleeding episode vs. those who did not was 3.29 vs. 2.24 (P value of 0.0009). Although not statistically significant, patients who had a bleeding episode were more likely to have renal dysfunction, alcohol use, be on prasugrel, and be on 325mg of aspirin.
  
  
  CONCLUSIONS
  The study shows that the HAS-BLED score can be of utility in risk stratifying patients in determining who can continue DAPT beyond 12 months. Furthermore, a HAS-BLED score of less than 2 may help guide extended DAPT beyond 12 months at minimal bleeding risk. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Ruchit R
authors.initials: RR
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Pillai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Omar
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: John
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Vishal
authors.initials: V
authors.lastname: Arora
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Deepak
authors.initials: D
authors.lastname: Kapoor
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
authors.forename: Paul
authors.initials: P
authors.lastname: Poommipanit
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011184:Postoperative Period; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: bleeding; drug eluting stent; dual anti-platelet therapy; percutaneous coronary intervention