@article { , title = {Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets}, abstract = {Objective: To develop and externally validate a prediction model for major bleeding in patients with a TIA or ischemic stroke on antiplatelet agents. Methods: We combined individual patient data from 6 randomized clinical trials (CAPRIE, ESPS-2, MATCH, CHARISMA, ESPRIT, and PRoFESS) investigating antiplatelet therapy after TIA or ischemic stroke. Cox regression analyses stratified by trial were performed to study the association between predictors and major bleeding. A risk prediction model was derived and validated in the PERFORM trial. Performance was assessed with the c statistic and calibration plots. Results: Major bleeding occurred in 1,530 of the 43,112 patients during 94,833 person-years of follow-up. The observed 3-year risk of major bleeding was 4.6\% (95\% confidence interval [CI] 4.4\%–4.9\%). Predictors were male sex, smoking, type of antiplatelet agents (aspirin-clopidogrel), outcome on modified Rankin Scale ≥3, prior stroke, high blood pressure, lower body mass index, elderly, Asian ethnicity, and diabetes (S2TOP-BLEED). The S2TOP-BLEED score had a c statistic of 0.63 (95\% CI 0.60–0.64) and showed good calibration in the development data. Major bleeding risk ranged from 2\% in patients aged 45–54 years without additional risk factors to more than 10\% in patients aged 75–84 years with multiple risk factors. In external validation, the model had a c statistic of 0.61 (95\% CI 0.59–0.63) and slightly underestimated major bleeding risk. Conclusions: The S2TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding.}, doi = {10.1212/WNL.0000000000004289}, eissn = {1526-632X}, issn = {0028-3878}, issue = {9}, journal = {Neurology}, publicationstatus = {Published}, publisher = {American Academy of Neurology}, url = {https://nottingham-repository.worktribe.com/output/879644}, volume = {89}, year = {2017}, author = {Hilkens, Nina A. and Algra, Ale and Diener, Hans-Christoph and Reitsma, Johannes B. and Bath, Philip M. and Csiba, Laszlo and Hacke, Werner and Kappelle, L. Jaap and Koudstaal, Peter J. and Leys, Didier and Mas, Jean-Louis and Sacco, Ralph L. and Amarenco, Pierre and Sissani, Leila and Greving, Jacoba P.} }