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Prognostic implications of early and long-term bleeding events in patients on one-year dual antiplatelet therapy following drug-eluting stent implantation

Musumeci G et al. – In DES–treated patients on prolonged dual antiplatelet therapy (DAPT), major bleeding occurring at 1 year and up to 4 years following drug–eluting stent (DES) implantation in patients on prolonged DAPT is associated with poor long–term prognosis.

Methods
  • A total of 1,437 patients undergoing DES implantation discharged on DAPT with aspirin and clopidogrel for 1 year were studied.
  • Patients were followed for up to 4 years (34.3 ± 14.4 months) and the prevalence and predictors of in–hospital and long–term thrombolysis in myocardial infarction (TIMI) major and minor bleeding events evaluated.
  • The impact of bleeding events on major adverse cardiac events (MACE), overall death, and stent thrombosis (ST) was also assessed.

Results
  • The incidences of 30 days major and minor bleeding were 1.3 and 3.3%, respectively.
  • The incidences of 1–year major and minor bleeding were 3.0 and 5.6%, respectively.
  • The incidences of major and minor bleeding up to 4–year follow–up were 3.6 and 6.9%, respectively.
  • At multivariable analysis, 1–year major bleeding was positively predicted by use of oral anticoagulants at hospital discharge [odds ratio (OR) = 13.4, 95% confidence interval (CI) 3.0–59.2, P = 0.001], anemia at admission (OR = 6.7, 95% CI = 2.7–16.5, P < 0.001) and use of glycoprotein IIb/IIIa inhibitors (OR = 2.7, 95% CI = 1.1–6.5, P = 0.03) and negatively predicted by male gender (OR = 0.39, 95% CI = 0.16–0.97, P = 0.042).
  • Overall, major bleeding at 1 year and at long–term follow–up was associated with an increased risk of MACE, cardiac death and ST.
  • Patients who had any bleeding event were more likely to prematurely discontinue antiplatelet therapy (50% vs. 9.6%, P < 0.001).
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