PIONEER-AF-PCI Bleeding Algorithm Calculator
- PIONEER-AF-PCI Bleeding Algorithm: Explanation and Clinical Context
The PIONEER-AF-PCI trial randomized patients with nonvalvular atrial fibrillation who underwent PCI with stent placement to one of three antithrombotic strategies and measured clinically significant bleeding at 12 months. The trial found lower rates of clinically significant bleeding in two rivaroxaban-based strategies compared with standard therapy using a vitamin K antagonist plus dual antiplatelet therapy. These regimen definitions (low-dose rivaroxaban plus a P2Y12 inhibitor; very-low-dose rivaroxaban plus DAPT; and VKA plus DAPT) are reproduced above so clinicians can apply trial-level risk estimates to their decision making. This calculator reports the trial-observed bleeding percentages and hazard ratios to provide a trial-derived estimate of relative bleeding risk depending on the chosen strategy, and flags dose adjustments when renal function is reduced. This tool is intended for educational/reference use and to summarize published trial arms; it does not replace individualized clinical assessment, guideline-directed antithrombotic decision-making, or consideration of regulatory dosing and contraindications.
Reference:
Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention. N Engl J Med. 2016;375:2423-2434. DOI:10.1056/NEJMoa1611594. Additional guidance and contextual interpretation referenced from ACC expert guidance and peer-reviewed reviews.
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