Academic Research Consortium for High Bleeding Risk (ARC-HBR) Criteria

Patients are considered to be at high bleeding risk when at least 1 major or 2 minor criteria are met:

1. This excludes vascular protection doses.
2. Baseline thrombocytopenia is defined as thrombocytopenia before PCI.
3. Active malignancy is defined as diagnosis within 12 months and/or ongoing requirement for treatment (including surgery, chemotherapy, or radiotherapy).
4. National Institutes of Health Stroke Scale (NIHSS) score ≥5.

• Identifies patients at significantly higher risk of major bleeding and all-cause mortality, informing antiplatelet duration and intensity.
• Referenced in the 2023 ESC guidelines for bleeding risk stratification in PCI.

• Use in adult patients undergoing percutaneous coronary intervention (PCI) before antithrombotic decisions.
• Applicable in both acute coronary syndrome (ACS) and chronic/stable coronary artery disease.

• Developed by the Academic Research Consortium (2019) to standardize high bleeding risk (HBR) in PCI.
• Proposed using large, prospective all-comer PCI registries (e.g., Bern PCI Registry).
• HBR is defined as ≥1 major or ≥2 minor criteria, calibrated to around ≥4% 1-year Bleeding Academic Research Consortium (BARC) type 3–5 bleeding and/or ≥1% 1-year intracranial hemorrhage (ICH).
• Meta-analyses show higher bleeding and modest discrimination (pooled relative risk around 2.6–2.7; c-statistic around 0.64–0.69) with suboptimal calibration (observed:expected ~1.47).

Always weigh bleeding risk against ischemic risk.

• Meets criteria:
  
  • Although bare-metal stents (BMS) were once preferred in high-bleeding-risk patients, drug-eluting stents (DES) are now favored in most cases.
  • Plan an abbreviated dual antiplatelet therapy (DAPT) course (often 1–3 months), followed by single antiplatelet therapy.
  • Monitor closely for evidence of bleeding
• Does not meet criteria:
  
  • Use standard DAPT durations per cardiology guidelines (e.g., 6–12 months).
  • Monitor for interval changes or evidence of bleeding.

• Use results alongside a thorough evaluation and specialist judgment.
• Bleeding risk may increase as more criteria are met; however, the tool is a binary classification, not a continuous risk score.