William French, MD - Anticoagulation: Special Populations - Figure 21

Major Risk Factors for Bleeding

This Figure lists the major risk factors for bleeding – advanced age, severe renal dysfunction, recent gastrointestinal bleed, prior stroke, or uncontrolled hypertension – and it is clear that this hypothetical patient case has presented with 2 of these 5 risk factors.[133]Now the critical clinical questions for managing such a patient will be:

which stent, bare metal or drug eluting?
continue on with full-dose triple therapy (antiplatelet plus anti-thrombin), or are modifications necessary?

Although clinicians do not always have an option to modify these regimens, but realizing the increased risk of bleeding in patients who must be in on triple therapy, it becomes particularly important to educate the patient, maintain very close follow-up of the patient, and given that use of a drug like warfarin is affected so much by a dietary and concomitant drug interactions, it becomes crucially important that physicians understand and to manage these patients more closely and more seriously.

French WJ. Am J Med 2013; 126: 00-00.

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References

[133] Paikin JS, Wright DS, Crowther MA, Mehta SR, Eikelboom JW. Triple antithrombotic therapy in patients with atrial fibrillation and coronary artery stents. Circulation. 2010;121:2067-2070.