Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry

Abstract

Aims To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population. Methods and results Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-of-hospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%. Conclusion During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.

Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: A 25-year individual patient level linkage study

“…The observation that subsequent bleeding rates doubled is likely to be a consequence of the increasing use of more potent anti-platelet and anti-thrombotic therapies. [53] The risk of recurrent stroke was reduced without change in bleeding rates, perhaps suggesting the management of other risk factors is responsible for improved outcomes. [15] …”

Effects of clopidogrel, prasugrel and ticagrelor on prevention of stent thrombosis in patients underwent percutaneous coronary intervention: A network meta‐analysis

“…A potent mediator for efficacy attenuation of ticagrelor outside RCT might be decreased compliance because of the higher rate of adverse events (dyspnea, bleeding), administration of the drug twice daily and higher costs 38‐40 . Additionally, the overall improvement in the clinical outcomes of patients with ACS 41 might be another possible explanation for the diminished benefit of ticagrelor in the modern era; particularly, this might be driven by progress in the use of drug‐eluting stents 42 and poststenting care.…”

Early or First Aid Administration Versus Late or In-hospital Administration of Aspirin for Non-traumatic Adult Chest Pain: A Systematic Review

“…From a risk perspective, it is unknown if there is an increased risk of bleeding from the administration of a single dose of aspirin. Bleeding within the group of patients with an MI has increased during the last two decades and is now around 2%, with the increase mainly attributed to the use of invasive treatment strategies known to affect the risk of bleeding, yet with the benefit of improved survival [13].…”