Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analyses

Abstract

BackgroundBleeding events have been associated with the use of antiplatelet agents. This study estimated the incidence of bleeding events in patients previously hospitalized for a serious coronary event and determined the risks of bleeding associated with the use of acetylsalicylic acid (ASA) and/or clopidogrel.MethodsA UK primary care database was used to identify 27,707 patients aged 50 to 84 years, hospitalized for a serious coronary event during 2000 to 2007 and who were alive 30 days later (start date). Patients were followed up until they reached an endpoint (hemorrhagic stroke, upper or lower gastrointestinal bleeding [UGIB/LGIB]), death or end of study [June 30, 2011]) or met an exclusion criterion. Risk factors for bleeding were determined in a nested case-control analysis.ResultsIncidences of hemorrhagic stroke, UGIB, and LGIB were 5.0, 11.9, and 25.5 events per 10,000 person-years, respectively, and increased with age. UGIB and LGIB led to hospitalization in 73 and 23 % of patients, respectively. Non-users of ASA, who were mostly discontinuers, and current users of ASA had similar risks of hemorrhagic stroke, UGIB, and LGIB. Users of combined antithrombotic therapy (warfarin and antiplatelets) experienced an increased risk of hemorrhagic stroke (odds ratio [OR], 6.36; 95 % confidence interval [CI], 1.34–30.16), whereas users of combined antiplatelet therapy (clopidogrel and ASA) experienced an increased risk of UGIB (OR, 2.42; 95 % CI, 1.09–5.36). An increased risk of LGIB (OR, 1.86; 95 % CI, 1.34–2.57) was also observed in users of clopidogrel.ConclusionsIn patients previously hospitalized for a serious coronary event, combined antithrombotic therapy was associated with an increased risk of hemorrhagic stroke, whereas combined antiplatelet therapy was associated with an increased risk of UGIB.Non-use of ASA was rare in this population and use of ASA was not associated with a significantly increased risk of hemorrhagic stroke, UGIB, or LGIB.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0348-6) contains supplementary material, which is available to authorized users.

Gastroenterological Perspectives on Acute Cardiac Care — the Management of Patients with Implanted Coronary Stents Following an Acute Coronary Syndrome

“…55,56 In a recent large cohort study which included 27,707 patients, Gonzalez-Perez et al concluded that 73% of patients with upper gastrointestinal bleeding and 23% of those with lower gastrointestinal bleeding, being on antiplatelet therapy for a serious coronary event, needed hospitalization. 57 In an observational study which included 122 patients, DAPT was associated with a significant decrease of hemoglobin levels (1.6, 95% CI: 1.2-1.8, p <0.001) and an increased prevalence of anemia after DAPT (9.1% vs. 45.9%).…”

Incidence of Upper and Lower Gastrointestinal Bleeding in New Users of Low-Dose Aspirin

“…As summarized in Supplementary Figure 1, a multistage process was undertaken to confirm the recorded diagnosis of UGIB or LGIB or unspecified GIB, involving at least 1 of the following validation processes: crosschecking with cases validated in previous studies, [21][22][23][24] linkage to HES data, and manual review of patient EMRs including free-text comments and data mining using text strings (see Supplementary Methods). Potential incident UGIB or LGIB cases were considered confirmed if there was evidence or referral to a consultant or hospitalization.…”

“…Fourthly, the recorded UGIB or LGIB diagnoses were validated through a multistep process, including linkage to hospitalization data or through manual review of patient records in THIN including the free text comments. Previous validation studies using questionnaires to PCPs as the gold standard have shown UGIB and LGIB Read codes in THIN to have PPVs of 95% and 82%, respectively [21][22][23][24] after manual review of medical records incorporating free text comments. A limitation of our study is that misclassification of low-dose aspirin could have occurred from individuals discontinuing their preventative treatment during follow-up-in censoring follow-up at 1 year after start of therapy, GI bleeding rates were slightly higher.…”

Increased affinity of endothelial cells to NiTi using ultraviolet irradiation: An in vitro study

“…To prevent such an excessive thrombotic event, anti‐platelet medication is given to patients before and after the endovascular implantation of metallic devices. The anti‐thrombotic medication carries the risk of spontaneous bleeding in organs such as brain and gastrointestinal tract . Therefore, it would be beneficial if the anti‐thrombotic medication is removed and a rapid endothelialization of the endovascular metallic devices is achieved.…”

“…The anti-thrombotic medication carries the risk of spontaneous bleeding in organs such as brain and gastrointestinal tract. 5,6 Therefore, it would be beneficial if the anti-thrombotic medication is removed and a rapid endothelialization of the endovascular metallic devices is achieved.…”