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. 2021 Jan 6;6(4):1–10. doi: 10.1001/jamacardio.2020.6814

Figure 3. Predicted Risks of Bleeding Academic Research Consortium (BARC) Types 3 to 5 Bleeding and Myocardial Infarction (MI) and/or Stent Thrombosis (ST) for Patients at High Bleeding Risk.

Figure 3.

A, Plot of predicted 1-year risk of MI and/or ST and BARC types 3 to 5 bleeding (log scales) in patients at high bleeding risk according to the Academic Research Consortium. The equal trade-off line corresponds to the points where the risk of either BARC types 3 to 5 bleeding or MI and/or ST occurrence is the same. The mortality-weighted line takes the associated mortality of both events into account. Two examples are provided. Patient 1 is a 56-year-old woman who presents with a non–ST-elevation MI. Her medical history includes a previous MI 2 years ago, diabetes, active smoking, and osteoporosis treated with long-term ibuprofen. Her hemoglobin level is 12.0 g/dL (to convert to grams per liter, multiply by 10.0) and estimated glomerular filtration rate (eGFR) is 40 mL/min. She was treated with complex percutaneous coronary intervention (4 drug-eluting stents [DES]) and discharged with a regimen of ticagrelor plus aspirin. Patient 2 is a 79-year-old man with atrial fibrillation taking an oral anticoagulant (OAC) who presents with exertional angina. He is an ex-smoker (stopped 2 years ago) with chronic obstructive lung disease and underwent a hemicolectomy for cancer 6 months ago. His hemoglobin level is 10.5 g/dL and eGFR is 70 mL/min. He was treated with percutaneous coronary intervention (single DES to the proximal left anterior descending coronary artery) and discharged with a regimen of clopidogrel and OAC. B, Subgroups of patients based on relative 1-year risk of MI and/or ST and BARC types 3 to 5 bleeding (log scale). The gray zone indicates 2931 of 6641 patients (44.1%) with a greater risk of a thrombotic event (MI and/or ST) than a BARC types 3 to 5 bleeding event. The orange zone indicates 1555 of 6641 patients (23.4%) with a mortality-weighted greater risk associated with a BARC types 3 to 5 event than with a thrombotic event (MI and/or ST). The white zone indicates 2155 patients (32.4%) who can be considered to face a comparable risk of either type of adverse event.