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Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analyses.
BMC Cardiovasc Disord. 2016 08 30; 16(1):164.BC

Abstract

BACKGROUND

Bleeding 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.

METHODS

A 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.

RESULTS

Incidences 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.

CONCLUSIONS

In 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.

Authors+Show Affiliations

Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain. Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain.Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain. Andalusian Bioinformatics Research Centre (CAEBi), Seville, Spain.AstraZeneca R&D, Mölndal, Sweden.AstraZeneca R&D, Mölndal, Sweden.Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain. lagarcia@ceife.es.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27577589

Citation

González-Pérez, Antonio, et al. "Risk of Bleeding After Hospitalization for a Serious Coronary Event: a Retrospective Cohort Study With Nested Case-control Analyses." BMC Cardiovascular Disorders, vol. 16, no. 1, 2016, p. 164.
González-Pérez A, Sáez ME, Johansson S, et al. Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analyses. BMC Cardiovasc Disord. 2016;16(1):164.
González-Pérez, A., Sáez, M. E., Johansson, S., Himmelmann, A., & García Rodríguez, L. A. (2016). Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analyses. BMC Cardiovascular Disorders, 16(1), 164. https://doi.org/10.1186/s12872-016-0348-6
González-Pérez A, et al. Risk of Bleeding After Hospitalization for a Serious Coronary Event: a Retrospective Cohort Study With Nested Case-control Analyses. BMC Cardiovasc Disord. 2016 08 30;16(1):164. PubMed PMID: 27577589.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analyses. AU - González-Pérez,Antonio, AU - Sáez,María E, AU - Johansson,Saga, AU - Himmelmann,Anders, AU - García Rodríguez,Luis A, Y1 - 2016/08/30/ PY - 2015/08/27/received PY - 2016/08/19/accepted PY - 2016/9/1/entrez PY - 2016/9/1/pubmed PY - 2017/6/22/medline KW - Acetylsalicylic acid KW - Bleeding KW - Clopidogrel KW - Coronary event KW - Dual antiplatelet therapy SP - 164 EP - 164 JF - BMC cardiovascular disorders JO - BMC Cardiovasc Disord VL - 16 IS - 1 N2 - BACKGROUND: Bleeding 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. METHODS: A 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. RESULTS: Incidences 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. CONCLUSIONS: In 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. SN - 1471-2261 UR - https://www.unboundmedicine.com/medline/citation/27577589/Risk_of_bleeding_after_hospitalization_for_a_serious_coronary_event:_a_retrospective_cohort_study_with_nested_case_control_analyses_ L2 - https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-016-0348-6 DB - PRIME DP - Unbound Medicine ER -