Validation of Academic Research Consortium for High Bleeding Risk Definition in East-Asian Patients (JACC Asia June 2023)-Article: Validation of Academic Research Consortium for High Bleeding Risk Definition in East-Asian Patients

Article: Validation of Academic Research Consortium for High Bleeding Risk Definition in East-Asian Patients

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The study aimed to validate the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria in East-Asian patients with acute coronary syndromes (ACS) undergoing invasive management. The research utilized data from the TICAKOREA trial, which involved 800 Korean ACS patients randomly allocated to receive either ticagrelor or clopidogrel. Patients were classified as high bleeding risk (HBR) if they met at least one major or two minor ARC-HBR criteria. The main outcomes assessed were Bleeding Academic Research Consortium 3 or 5 bleeding and major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stroke over 12 months.<br /><br />The results indicated that 16.3% of the patients were categorized as HBR. These patients exhibited significantly higher incidences of both bleeding (10.7% vs 3.8%) and MACE (14.3% vs 6.1%) compared to non-HBR patients. Additionally, HBR patients had a higher burden of comorbidities and were less frequently discharged on certain medications like beta-blockers and statins.<br /><br />Furthermore, the study evaluated the differential impact of ticagrelor and clopidogrel on bleeding and ischemic outcomes. It was found that ticagrelor users experienced more significant bleeding compared to clopidogrel in the non-HBR group, whereas no significant difference was observed in the HBR group. Ischemic outcomes, however, did not significantly differ between the two drugs in either group.<br /><br />The study concluded that the ARC-HBR criteria are valid for identifying East-Asian ACS patients at increased risk of bleeding and ischemic events. However, the criteria's ability to differentiate the effects of various antiplatelet regimens requires further investigation. The researchers suggested that larger studies across diverse clinical settings are needed to explore the implications of these findings further.

Keywords

ARC-HBR criteria

East-Asian patients

acute coronary syndromes

TICAKOREA trial

ticagrelor

clopidogrel

high bleeding risk

major adverse cardiovascular events

bleeding outcomes

ischemic outcomes