Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients

Abstract

Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.

Incidence and outcome of gastrointestinal bleeding in patients receiving aspirin with or without clopidogrel over 10 years- An observational study

“…[ 11 ] A retrospective Chinese study over 6 years on elderly patients above 75 years age who underwent PCI reported a GI bleed rate of 16.5% with no rebleed after reintroduction of drugs. [ 6 ] Western studies appear to have lower incidence of GI bleed in the long term (i.e. it falls off in later years) but our results are more in conformity with the Chinese study.…”

“…[ 5 ] Data are sparser from the eastern world. [ 6 ] The present study was aimed to delineate the long term incidence of GI bleed, rebleed, treatment outcome and mortality as also any difference therein among the patient groups receiving the above medications for various indications. With rising elderly population in resource limited Indian settings, many primary care providers will have to deal with problems in this patient group early in their course.…”

Gender Disparities in Patients’ Decisions about the Management of Myocardial Infarction in East Chinese Province

“…As shown in this study, female patients of AMI were much older, had lower levels of education with more of them living without their spouses, and therefore were more likely to neglect the necessity of longterm medication including antiplatelet therapy and statins. Besides, female patients of AMI were more likely to have complications caused by antiplatelet therapy and statins [30][31][32]. Tis might also be one of the reasons why more female patients of AMI were poorly adherent to antiplatelet therapy and statins.…”