{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:08:10Z","timestamp":1792195690955,"version":"4.4.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Whether the underlying risk of bleeding influences the associations between patterns of dual antiplatelet therapy (DAPT) cessation and adverse events after percutaneous coronary intervention is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients enrolled in the prospective, international, multicenter PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were categorized according to their risk of bleeding using the PARIS bleeding risk score. We evaluated the incidence, patterns, and association between modes of DAPT cessation and outcomes across bleeding risk groups. Modes of DAPT cessations were defined as physician-guided DAPT discontinuation, brief interruption (&lt;14 days) or disruption for bleeding, or noncompliance. The primary end point of interest was major adverse cardiac events, defined as the composite of cardiac death, myocardial infarction, or definite-probable stent thrombosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      From a total of 5018 patients, 513 (10.2%) were classified as high, 2058 (41.0%) as intermediate, and 2447 (48.8%) as low risk for bleeding. High bleeding risk (HBR) patients were older and had greater prevalence of comorbidities. Compared with non-HBR, HBR patients had higher rates of both ischemic and bleeding events. The cumulative incidence of DAPT cessation was higher in HBR patients, mostly driven by physician-guided discontinuation and disruption. Of note, DAPT disruption occurred in 17.7%, 10.4%, and 7.8% at 1 year and 22.0%, 15.1%, and 12.0% at 2 years (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001) in high, intermediate, and low bleeding risk groups, respectively. Physician-guided DAPT discontinuation was not associated with increased risk of major adverse cardiac events in both HBR and non-HBR patients, while DAPT disruption was associated with an increased risk of major adverse cardiac events across all bleeding risk groups. There was no interaction between bleeding risk status and clinical outcomes for any cessation mode.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patients at HBR remain at higher risk of adverse events. Disruption of DAPT is associated with an increased risk of major adverse cardiac events irrespective of the underlying bleeding risk. Physician-guided discontinuation of DAPT appears to be safe, irrespective of HBR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.119.008226","type":"journal-article","created":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T05:00:36Z","timestamp":1585285236000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Bleeding Risk, Dual Antiplatelet Therapy Cessation, and Adverse Events After Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"13","author":[{"given":"Sabato","family":"Sorrentino","sequence":"first","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."},{"name":"Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (S. Sorrentino)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Sartori","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usman","family":"Baber","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bimmer E.","family":"Claessen","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Giustino","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaya","family":"Chandrasekhar","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Chandiramani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section: Cardiovascular Disease, St. Luke\u2019s Mid America Heart Institute, University of Missouri-Kansas City, The Christ Hospital Heart and Vascular Center, (D.J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Henry","sequence":"additional","affiliation":[{"name":"The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH (T.D.H.)."},{"name":"Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN (T.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Guedeney","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cono","family":"Ariti","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Dangas","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."},{"name":"Department of Cardiology, National and Kapodistrian University of Athens, Greece (G.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Michael","family":"Gibson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (C.M.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell W.","family":"Krucoff","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Duke University School of Medicine, Durham, NC (M.W.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Moliterno","sequence":"additional","affiliation":[{"name":"Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington (D.J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Colombo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgit","family":"Vogel","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaide","family":"Chieffo","sequence":"additional","affiliation":[{"name":"Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy (A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annapoorna S.","family":"Kini","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (S. Sorrentino, S. Sartori, U.B., B.E.C., G.G., J.C., J.C., P.G., G.D., B.V., A.S.K., R.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Witzenbichler","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giora","family":"Weisz","sequence":"additional","affiliation":[{"name":"Cardiology Department, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe Gabriel","family":"Steg","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Diderot, Sorbonne Paris-Cit\u00e9, France (P.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Pocock","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (C.A., S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Urban","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hopital LaTour, Geneva, Switzerland (P.U.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5546-262X","authenticated-orcid":false,"given":"Roxana","family":"Mehran","sequence":"additional","affiliation":[{"name":"Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. 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