- The S2TOP-BLEED score may be helpful to identify patients on antiplatelet therapy following a transient ischemic attack or ischaemic stroke that are at high risk of bleeding.
- The S2TOP-BLEED score may help identify a sub group of high risk patients where gastro protective agents could be used.
- This study is important because it evaluates the performance of the S2TOP-BLEED score in a ‘real life’ population-based cohort of patients rather than a clinical trial setting
Following a transient ischemic attack (TIA) or ischemic stroke patients are given lifelong antiplatelet therapy to help prevent a second event. Antiplatelet drugs can cause bleeding side effects and these can be life threatening. Finding ways to identify those most at risk is therefore of great importance. Gastro protection can be used in those at high risk to help prevent bleeds.
The S2TOP-BLEED score was developed from 6 randomised clinical trials with over 43,000 patients and was then validated in the PERFORM trial which included 19000 patients who had experienced a recent TIA or ischemic stroke. Clinical trials do not represent real life situations as certain patients e.g. the frail or elderly are often excluded. This study therefore looks at the performance of this score in a population cohort of patients in order to understand how it works in a real life setting. The study included 2072 patients from OXVASC between 2002 and 2012.
The study showed that the S2TOP-BLEED score compares well to other clinical scores and can be used to estimate the risk of major bleeding side effects with patients who are on antiplatelet therapy following a TIA or ischemic stroke. For most patients the risk of recurrent ischemic events outweighs the risk of a bleed but the score can be used to help identify those at particularly high risk so that preventative gastro protective measures can be considered.
For further information see: Hilkens NA, Linxin L, Rothwell P et al external validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients. Stroke 2018;49:601-606