One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction

Lattuca, Benoît; Fabbro‐Peray, Pascale; Leclercq, Florence; Schmutz, Laurent; Ledermann, Bertrand; Cornillet, Luc; Bénezet, Jean-François; Macia, Jean‐Christophe; Coussaye, Jean-Emmanuel de La; P, Messner-Pellenc; Cayla, Guillaume

doi:10.1016/j.acvd.2016.01.009

Cited by 7 publications

(4 citation statements)

References 47 publications

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“…Besides, the significant excess in non-CABG-related TIMI bleeding was not seen in STEMI patients undergoing PCI 43,44 . Contradictory findings in some observational studies reported the lower incidence of major bleeding with prasugrel 45,46 . Our network meta-analysis provided a more reliable conclusion by integrating direct and indirect evidence for analysis.…”

Section: Discussionmentioning

confidence: 88%

Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

Fei

Lam

Cheung

2020

Sci Rep

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Whether newer P2Y12 inhibitors are more efficacious and safer than clopidogrel and whether there is a superior one remain uncertain. We compared the effect of P2Y12 inhibitors on clinical outcomes in patients with acute coronary syndrome (ACS). Randomized controlled trials comparing clopidogrel, prasugrel, ticagrelor, or cangrelor, in combination with aspirin were searched. Sixteen trials with altogether 77,896 patients were included. Compared to clopidogrel, cardiovascular mortality was reduced with prasugrel (OR 0.85, 95% CI 0.75–0.97) and ticagrelor (0.82, 0.73–0.93). Myocardial infarction (0.75, 0.63–0.89) and major adverse cardiovascular events (0.80, 0.69–0.94) were reduced by prasugrel. Stent thrombosis was reduced by prasugrel (0.49, 0.38–0.63), ticagrelor (0.72, 0.57–0.90), and cangrelor (0.59, 0.43–0.81). It was reduced more by prasugrel than ticagrelor (0.69, 0.51–0.93). There were more major bleeds with prasugrel (1.24, 1.05–1.48). Thrombolysis in Myocardial Infarction (TIMI) major bleeding was increased with prasugrel compared to clopidogrel (1.36, 1.11–1.66) and ticagrelor (1.33, 1.06–1.67). TIMI minor bleeding was increased with prasugrel (1.44, 1.16–1.77) and cangrelor (1.47, 1.01–2.16) compared to clopidogrel while it was increased with prasugrel compared to ticagrelor (1.32, 1.01–1.72). Prasugrel is preferable to those ACS patients at low bleeding risk to reduce cardiovascular events whereas ticagrelor is a relatively safe antiplatelet drug of choice for most patients.

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Section: Discussionmentioning

confidence: 88%

Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

Fei

Lam

Cheung

2020

Sci Rep

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“…For example, previous studies concluded that there was no difference in bleeding incidence between prasugrel and clopidogrel [20, 21]. Other studies demonstrated that prasugrel, compared to clopidogrel, had more frequent minor/minimal bleeding events but fewer incidences of major bleeding events [22, 23]. The findings of the presented study determined that patients receiving prasugrel had a lower incidence of in-hospital major bleeding events compared to those administered clopidogrel, agreeing with the latter previous studies with long-term follow-up [22, 23].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies demonstrated that prasugrel, compared to clopidogrel, had more frequent minor/minimal bleeding events but fewer incidences of major bleeding events [22, 23]. The findings of the presented study determined that patients receiving prasugrel had a lower incidence of in-hospital major bleeding events compared to those administered clopidogrel, agreeing with the latter previous studies with long-term follow-up [22, 23]. The lower incidence of major bleeding among the prasugrel group may be explained by selection bias such that prasugrel is prescribed to patients with a low risk of bleeding [22, 24].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database ACTION Registry

Khayata¹,

Gabra²,

Nasser³

et al. 2017

Cardiol Res

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BackgroundWe aimed to compare the clinical outcomes of clopidogrel, prasugrel, and ticagrelor in clinical practice using the National Cardiovascular Database ACTION Registry®. Treatment guidelines for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention recommend dual antiplatelet therapy (DAPT) for 12 months. Few clinical trials have compared the safety and efficacy of clopidogrel with that of newer antiplatelet therapies.MethodsA retrospective study of patients hospitalized for ACS at Cleveland Clinic Akron General was conducted. Data elements included detailed medical history and clinical outcomes during hospital stay. The primary outcome was a composite of major clinical events (cardiogenic shock, atrial fibrillation, ventricular fibrillation, ventricular tachycardia, heart failure, bleeding, and mechanical ventilation). The independent variable was the type of DAPT. Statistical analyses were performed using Chi-square and Mann-Whitney U tests. A post-hoc analysis was performed to compare between the antiplatelet drugs head-to-head.ResultsSubjects (n = 1,388) admitted between January 2011 and March 2016 with ACS and treated with clopidogrel, prasugrel, or ticagrelor were included in the study. Mean age was 65 ± 14 years and 46% had ST-segment elevation myocardial infarction. Prasugrel administration within 24 h was associated with a lower incidence of the composite outcome (P = 0.049), bleeding (P = 0.028), and heart failure (P = 0.002).ConclusionThere was a significant difference between the type of antiplatelet drug and clinical outcomes in ACS patients who were treated with DAPT. Observations from current study may provide important information for prescribers in clinical decision-making.

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“…We identified potential predictors of bleeding by reviewing previously published risk scores for in-hospital and postdischarge bleeding events, [8][9][10][11][12][13][14][19][20][21] as well as studies that had reported on characteristics associated with bleeding after ACS. [22][23][24][25][26] Nineteen potential predictors were selected for inclusion in the study on the basis of clinical judgement.…”

Section: Predictorsmentioning

confidence: 99%

Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors

Ismail

Jordan

Kadam

et al. 2019

JAHA

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BackgroundThe incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome.Methods and ResultsWe used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person‐years (95% CI, 157–167/1000 person‐years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event.ConclusionsBleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk‐benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy.

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One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction

Cited by 7 publications

References 47 publications

Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta-analysis

Comparison of Clopidogrel With Prasugrel and Ticagrelor in Patients With Acute Coronary Syndrome: Clinical Outcomes From the National Cardiovascular Database ACTION Registry

Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors

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