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Gastrointestinal bleeding in high risk survivors of myocardial infarction: The VALIANT Trial
European Heart Journal, 06/30/09

Moukarbel GV et al. – Following myocardial infarction (MI), clinical characteristics can identify pts with increased risk of gastrointestinal (GI) bleeding. Use of dual anti-platelet agents appears to be the most profound risk factor, but whether these pts would benefit from GI prophylaxis therapy remains unknown.

• Study of risk factors for GI bleeding in pts following MI
• VALsartan In Acute myocardial iNfarcTion trial (VALIANT): 14,703 post-MI pts with left ventricular dysfunction and/or heart failure
• Median 24.7-mo follow-up
• Secondary analysis of times from baseline to first GI bleeding from VALIANT serious adverse event database
• Evaluation of potential risk factors from medical history, demographics, clinical profile, and medications, both at baseline and during follow-up
• Assessment of the relationship between occurrence of GI bleeding and subsequent mortality

• During follow-up, serious GI bleeding event for 98 (0.7%) pts
• GI bleeding pts: older, more comorbidities, more likely to take additional antiplatelet drugs, worse left ventricular systolic and renal function
• Kaplan–Meier estimated rate of GI bleeding at 6 mo: 0.37%
• In multivariable Cox model, dual antiplatelet therapy was most powerful predictor of GI bleeding (adjusted hazard ratio of 3.18)
• Other predictors: non-white race, history of alcohol abuse, increasing age, worse New York Heart Association class, anticoagulant therapy, diabetes, lower estimated glomerular filtration rate, and male sex
• Gastrointestinal bleeding associated with increased risk of death

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