Use of ISTH bleeding assessment scale to evaluate therapy-associated bleeding risk in patients undergoing coronary revascularization

Background — Currently, there is a challenge in the dynamic prognostic assessment of haemorrhagic risks, particularly in recognising the development of bleeding in patients who have undergone cardiac surgery (CS). Bleeding frequently occurs in post-CS patients as they are receiving antithrombotic therapy (ATT), prescribed for continuous a period of 3, 6, or 12 months after surgery. This not only worsens prognosis and quality of life but also, if therapy is discontinued, increases the risk of thrombotic events. Objective — To investigate the diagnostic value of scales for assessing bleeding and predicting bleeding outcomes in individuals who have undergone myocardial revascularisation, and to assess the applicability of the ISTH scale for evaluating bleeding in this patient group. Methods — A total of 98 patients undergone myocardial revascularisation participated in the prospective study. An assessment of hemorrhagic risks according to the PRECISE-DAPT scale and hemorrhagic manifestations according to the ISTH scale was performed at visit 1 and 2 (0-1 month after revascularization). Results — It was found that the assessment of bleeding risk during antithrombotic therapy (ATT) in the first month after myocardial revascularisation, when performed using the PRECISE-DAPT scale, is not comparable to the assessment using the ISTH scale. However, the ISTH scale proved to be a useful tool for evaluating haemorrhagic complications of ATT in patients following cardiac surgery (CS). Conclusion — The use of the ISTH scale allows the assessment of early signs of bleeding during dual antiplatelet therapy (DAPT) following revascularisation, helping to foster a proactive attitude in patients towards monitoring complications of antithrombotic therapy. This approach can reduce risks of fatal haemorrhages and the development and progression of anaemia. However, the ISTH scale is not comparable to the PRECISE-DAPT scale for assessing hemorrhagic risks and cannot be recommended for dynamic prediction of hemorrhagic risks in post-CS patients.