Practical Assessment of the Tradeoff between Fatal Bleeding and Coronary Thrombotic Risks using the Academic Research Consortium for High Bleeding Risk Criteria

• Published in: Journal of Atherosclerosis and Thrombosis 2022/08/01, Vol.29(8), pp.1236-1248
• Main Authors: Sotomi, Yohei, Hikoso, Shungo, Nakatani, Daisaku, Dohi, Tomoharu, Mizuno, Hiroya, Okada, Katsuki, Kida, Hirota, Oeun, Bolrathanak, Sunaga, Akihiro, Sato, Taiki, Kitamura, Tetsuhisa, Sakata, Yasuhiko, Sato, Hiroshi, Hori, Masatsugu, Komuro, Issei, Sakata, Yasushi
• Format: Article
• Language: English
• Subjects: Academic Research Consortium; High bleeding risk; Myocardial infarction; Original; Thrombotic risk; Tradeoff
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.62999

Aims: We aimed to establish a practical method for the assessment of tradeoff between thrombotic and bleeding risks.Methods: We aimed to investigate the balance between bleeding risk and coronary thrombotic risk according to the number of the Academic Research Consortium for high bleeding risk (ARC-HBR) criteria in the multicenter prospective ST/non-ST elevation myocardial infarction (STEMI/NSTEMI) registry (N=12,093). Patients were divided as follows by the number of ARC-HBR criteria fulfilled: group 0, 0 major with ≤ 1 minor (N=6,792); group 1, 1 major with 0 minor (N=1,705); group 2, 0 major with ≥ 2 minors (N=790); group 3, 1 major with ≥ 1 minor (N=1,709); group 4, 2 majors with ≥ 0 minors (N=861); and group 5, ≥ 3 majors with ≥ 0 minor (N=236). We assessed the acute-phase absolute risk differences between bleeding and coronary thrombotic events in each group.Results: At 7-day follow-up, all patients (groups 0–5) had a higher risk of major bleeding than that of any myocardial infarction (MI). Patients at ARC-HBR (groups 1–5) had a balanced risk between fatal MI and fatal bleeding, whereas patients at non-ARC-HBR (group 0) had a higher risk of fatal MI than that of fatal bleeding.Conclusions: All STEMI/NSTEMI patients have a relatively high risk of major bleeding as compared with the risk of any MI in the acute phase. The ARC-HBR criteria would be a practical tool for assessing the tradeoff between fatal bleeding and fatal MI risks. This practical assessment would be helpful for the optimal decision-making of appropriate treatment strategy considering the balance between bleeding and coronary thrombotic risks.