ACS/MI

Question 1

What are the major criterion in the ARC-HBR scoring?

Answer 1

• Anticipated use of long-term OAC
• Severe or ESRD (eGFR < 30ml/min)
• Hb <11g/dL
• Spontaneous bleeding requiring hospitalisation or transfusion in past 6 months, or at any time if recurrent
• Moderate to severe baseline thrombocytopenia (<100x109)
• Chronic bleeding conditions
• Liver cirrhosis w portal HTN
• Active malignancy in past 12 months (excl nonmelanoma skin cancer)
• Prev spontaneous ICH (any time)
• Prev traumatic ICH (past 12 months)
• Mod-severe stroke (past 6 months)
• Nondeferrable major surgery w DAPT
• Recent major surgery or major trauma within 30d before PCI

Question 2

What are the minor criterion in the ARC-HBR scoring?

Answer 2

• Age ≥ 75yo
• Moderate CKD (eGFR 30-59 ml/min)
• Hb 11-12.9g/dL (M), 11-11.9g/dL (W)
• Spontaneous bleeding requiring hospitalisation or transfusion in past 12 months not meeting major criteria
• Long-term use of PO NSAID or steroids
• Any ischemic stroke at any time not meeting the major criterion

Question 3

How is the ARC-HBR score interpreted?

Answer 3

1 major or 2 minor criterion is considered high bleeding risk

Consider stopping P2Y12i after 3 months if patient has high bleeding risk
(high bleed risk should not completely deter you from giving DAPT)