A total of 1054 patients were included; detailed information for risk score calculation was available in 922 patients, who represent the population of the present analysis. ACS was the clinical indication for percutaneous coronary intervention in 529 patients (54.4%). Drug-eluting stents were implanted in 93% of the cases. Clopidogrel was administered to 56% of the overall population, although 66% of ACS patients received prasugrel or ticagrelor. DAPT was prescribed for 12 months to 81% of patients with ACS and for 6 months to 29% of patients with stable coronary artery disease. Based on investigator’s perception, 116 patients (12.6%) were estimated to be at high bleeding risk; the rate significantly increased to 38.3%, 19.4%, 49.8%, and 18.1% when calculated with PRECISE-DAPT, PARIS, ACUITY-HORIZON, and CRUSADE, respectively (all P values< 0.001). The correlation between perceived and calculated bleeding risk was significant (all P values< 0.001) but modest (R coefficient 0.565 for PARIS, 0.577 for CRUSADE, 0.472 for ACUITY-HORIZON, and 0.548 for PRECISE-DAPT). Figure reports the rate of patients receiving a SDAPT according to the level of perceived or calculated risk in the overall population (A) and in ACS (B). Among patients with ACS at perceived high bleeding risk, 77.7% received clopidogrel and 22.3% prasugrel or ticagrelor (P< 0.001). In patients with ACS, multivariate analysis revealed age> 75 years, baseline hemoglobin level, and high perceived bleeding risk as independent predictors both for SDAPT prescription and use of clopidogrel; however, patients at perceived high bleeding risk were almost 4 times more likely to receive clopidogrel rather than prasugrel or ticagrelor (odds ratio, 3.7 [95% CI, 2.0–6.79]; P< 0.001) and more than 2 times more likely to receive a SDAPT rather than a long duration of dual antiplatelet therapy (odds ratio, 2.4 [95% CI, 1.3–4.4]; P= 0.005).

Our data suggest that physicians seem to take into account bleeding risk when prescribing DAPT regimes and duration. Nevertheless, our analysis suggests only a moderate correlation between perceived and calculated bleeding risk, with some of the bleeding risk scores identifying 2 times greater numbers of patients at high bleeding risk than perceived by their treating clinicians. Patients at perceived high bleeding risk were more likely to receive clopidogrel instead of prasugrel or ticagrelor and SDAPT instead of long duration of dual antiplatelet therapy. Our analysis is subject to several limitations, we cannot exclude that clopidogrel choice is influenced by a higher baseline risk profile affecting both ischemic and bleeding risk; patients receiving clopidogrel compared with prasugrel have usually more comorbidities and previous cardiovascular events. 4 Furthermore our data does not capture bleeding events post discharge and so are unable to determine how well perceived and calculated bleeding risk correlate with major bleeding