{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:43:28Z","timestamp":1792291408075,"version":"4.4.0"},"reference-count":29,"publisher":"BMJ","issue":"15","funder":[{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002336","name":"Daiichi Sankyo Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2017,1,5]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there are no decision support tools available to predict an individual patient\u2019s bleeding risk during DAPT treatment in the post-ACS setting.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>To develop a longitudinal bleeding risk prediction model, we analy sed 9240 patients with unstable angina\/non-ST segment elevation myocardial infarction (NSTEMI) from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial, who were managed without revasculari sation and treated with DAPT for a median of 14.8 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 10 significant baseline predictors of non-coronary artery bypass grafting (CABG)-related Global Use of Strategies to Open Occluded Arteries (GUSTO) severe\/life-threatening\/moderate bleeding: age, sex, weight, NSTEMI (vs unstable angina), angiography performed before randomi sation, prior peptic ulcer disease, creatinine, systolic blood pressure, haemoglobin and treatment with beta-blocker. The five significant baseline predictors of Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding included age, sex, angiography performed before randomi sation, creatinine and haemoglobin. The models showed good predictive accuracy with Therneau\u2019s <jats:italic>C-<\/jats:italic>indices: 0.78 (SE = 0.024) for the GUSTO model and 0.67 (SE = 0.023) for the TIMI model. Internal validation with bootstrapping gave similar <jats:italic>C<\/jats:italic>-indices of 0.77 and 0.65, respectively. External validation demonstrated an attenuated <jats:italic>C<\/jats:italic>-index for the GUSTO model (0.69) but not the TIMI model (0.68).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Longitudinal bleeding risks during treatment with DAPT in patients with ACS can be reliably predicted using selected baseline characteristics. The TRILOGY ACS bleeding models can inform risk \u2013benefit considerations regarding the duration of DAPT following ACS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT00699998\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT00699998<\/jats:ext-link>\n                  <\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2016-310090","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T21:02:52Z","timestamp":1491426172000},"page":"1168-1176","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["Predicting the risk of bleeding during dual antiplatelet therapy after acute coronary syndromes"],"prefix":"10.1136","volume":"103","author":[{"given":"Joakim","family":"Alfredsson","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"},{"name":"Department of Cardiology and Department of Medical and Health Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Neely","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L","family":"Neely","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart & Vascular Center and Harvard Medical School, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun G","family":"Goodman","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, St. Michael\u2019s Hospital, Toronto, Canada"},{"name":"Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Tricoci","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"},{"name":"Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W","family":"Mahaffey","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University, Stanford, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan H","family":"Cornel","sequence":"additional","affiliation":[{"name":"Medisch Centrum Alkmaar, Alkmaar, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harvey D","family":"White","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith AA","family":"Fox","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorairaj","family":"Prabhakaran","sequence":"additional","affiliation":[{"name":"Centre for Chronic Disease Control and Public Health Foundation of India, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J","family":"Winters","sequence":"additional","affiliation":[{"name":"Eli Lilly and Company, Indianapolis, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Magnus","family":"Ohman","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"},{"name":"Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T","family":"Roe","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, USA"},{"name":"Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,4,5]]},"reference":[{"key":"2025092101174139000_103.15.1168.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"2025092101174139000_103.15.1168.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"2025092101174139000_103.15.1168.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"2025092101174139000_103.15.1168.4","first-page":"267","article-title":"ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task force for the management of acute coronary syndromes in patients presenting without persistent ST-Segment elevation of the european society of cardiology (ESC)","volume":"2016","author":"Roffi","year":"2015","journal-title":"Eur Heart 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