Chronic Limb-Threatening Ischemia is a Residual Bleeding Risk Factor among Patients with Lower Extremity Artery Disease

Abstract

Aim: Lower-extremity artery disease (LEAD) is a high-risk factor for bleeding. However, the specific risk factors for bleeding in patients with LEAD remain unclear. We aimed to identify risk factors for bleeding in patients with LEAD after endovascular treatment (EVT). Methods: This multicenter, retrospective, observational study included 732 consecutive patients with LEAD who underwent EVT between January 2018 and December 2019. Patient characteristics, laboratory data, target lesions, and medications were compared between patients with and without chronic limb-threatening ischemia (CLTI). Predictive bleeding risk factors were explored using Cox regression analysis with differential models. Results: In model 1, a body mass index (BMI) ＜18.5 kg/m 2 , prior heart failure, high bleeding risk, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were predictive bleeding risk factors (hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.13-3.52; p ＜0.01; HR 2.15; 95% CI 1.28-3.55; p ＜0.01; HR 3.40; 95% CI 1.28-3.55; p ＜0.01; HR 2.05; 95% CI 1.33-5.84; p ＜0.01; respectively). In model 2, a BMI ＜18.5 kg/m 2 , prior heart failure, anemia (＜11 g/dL), low platelet count (＜10*10 4 /µL), chronic kidney disease, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were independent risk factors for bleeding (model 2: HR 2.05; 95% CI 1.12-3.56; p =0.02; HR 2.35; 95% CI 1.39–3.90; p ＜0.01; HR 2.71; 95% CI 1.64–4.50; p ＜0.01; HR 2.66; 95% CI 1.00–5.89; p =0.05; HR 2.47; 95% CI 1.25–5.45; p ＜0.01; HR 2.79; 95% CI 1.24-5.63; p =0.01; respectively) Conclusions: CLTI is a residual and predictive risk factor for bleeding in patients with LEAD. We have to pay attention to the bleeding events of patients with CLTI after EVT during follow-up.

Utility of the ACD-GENE-CLI Score in Asian Patients with Critical Limb Ischemia Undergoing Endovascular Interventions

“…To maintain the patency of target vessels after endovascular intervention, the use of antiplatelet drugs to suppress platelet reactivity is crucial [7][8][9] . Clopidogrel is frequently prescribed in Asians and is associated with a lower risk of gastrointestinal bleeding compared with aspirin or other P2Y12 inhibitors 8,[10][11][12] . However, loss-offunction (LOF) alleles of the cytochrome P450 2C19 (CYP2C19) enzyme are associated with a poor response to clopidogrel and result in high platelet reactivity 8,13) .…”