Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective

Holm, Anna; Lawesson, Sofia Sederholm; Zolfagharian, Shima; Swahn, Eva; Ekstedt, Mattias; Alfredsson, Joakim

doi:10.1016/j.thromres.2018.05.023

Cited by 7 publications

(6 citation statements)

References 45 publications

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“…In accordance with previous studies, we observed a higher incidence of in-hospital bleeding complications in women [28,32,33]. Even after adjustment for baseline differences in bleeding risk factors, women had higher bleeding risk.…”

Section: Discussionsupporting

confidence: 92%

Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy - results from assessing platelet activity in coronary heart disease (APACHE)

Holm¹,

Swahn²,

Lawesson³

et al. 2020

Platelets

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Section: Discussionsupporting

confidence: 92%

Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy - results from assessing platelet activity in coronary heart disease (APACHE)

Holm¹,

Swahn²,

Lawesson³

et al. 2020

Platelets

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“…Female sex was associated with decreased risk of post-discharge bleeding in our study cohort, in line with the PLATO trial where female sex was associated with an overall lower risk for spontaneous (non-procedure) major bleed 9 , 39 . Other studies have found diverging results regarding an association between female sex and bleeding risk post-discharge 29 , 40 – 42 . Women seem to have more minimal and nuisance bleeding complications post-discharge compared to men 16 , 40 , small bleedings that was not included in our cohort study.…”

Section: Discussionmentioning

confidence: 89%

Incidence and predictors of serious bleeding during long-term follow-up after acute coronary syndrome in a population-based cohort study

Graipe

Ulvenstam

Irevall

et al. 2021

Sci Rep

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Progress in decreasing ischemic complications in acute coronary syndrome (ACS) has come at the expense of increased bleeding risk. We estimated the long-term, post-discharge incidence of serious bleeding, characterized bleeding type, and identified predictors of bleeding and its impact on mortality in an unselected cohort of patients with ACS. In this population-based study, we included 1379 patients identified with an ACS, 2010–2014. Serious bleeding was defined as intracranial hemorrhage (ICH), bleeding requiring hospital admission, or bleeding requiring transfusion or surgery. During a median 4.6-year follow-up, 85 patients had ≥ 1 serious bleed (cumulative incidence, 8.6%; 95% confidence interval (CI) 8.3–8.9). A subgroup of 557 patients, aged ≥ 75 years had a higher incidence (13.4%) than younger patients (6.0%). The most common bleeding site was gastrointestinal (51%), followed by ICH (27%). Sixteen percent had a recurrence. Risk factors for serious bleeding were age ≥ 75 years, lower baseline hemoglobin (Hb) value, previous hypertension or heart failure. Serious bleeding was associated with increased mortality. Bleeding after ACS was fairly frequent and the most common bleeding site was gastrointestinal. Older age, lower baseline Hb value, hypertension and heart failure predicted bleeding. Bleeding did independently predict mortality.

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“…It is known that women discontinue with DAPT more often than men [32,33], and that they have a higher risk of bleeding. [9,11,[34][35][36]. In the current study women tolerated TAT less well than men and discontinued TAT to a high extent, most often due to bleeds.…”

Section: Plos Onementioning

confidence: 58%

Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy–An observational study

et al. 2021

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Objectives Bleeding is the most common non-ischemic complication in patients with coronary revascularisation procedures, associated with prolonged hospitalisation and increased mortality. Many factors predispose for bleeds in these patients, among those sex. Anyhow, few studies have characterised the population receiving triple antithrombotic therapy (TAT) as well as long term bleeds from a sex perspective. We investigated the one year rate of bleeds in patients receiving TAT, potential sex disparities and premature discontinuation of TAT. We also assessed health care costs in bleeders vs non-bleeders. Setting Three hospitals in the County of Östergötland, Sweden during 2009–2015. Participants All patients discharged with TAT registered in the SWEDEHEART registry. Primary and secondary outcome measures All bleeds receiving medical attention during one-year follow-up were collected by retrieving relevant information about each patient from medical records. Resource use associated with bleeds was assigned unit cost to estimate the health care costs associated with bleeding episodes. Results Among 272 patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p = 0.01) and bled more (48.6 vs. 37.1%, p = 0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively. Conclusion The high bleeding incidence in patients with TAT, especially in women, is a cause of concern. There is a need for an adequately sized randomised, controlled trial to determine a safe but still effective treatment for these patients.

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Bleeding complications after myocardial infarction in a real world population - An observational retrospective study with a sex perspective

Cited by 7 publications

References 45 publications

Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy - results from assessing platelet activity in coronary heart disease (APACHE)

Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy - results from assessing platelet activity in coronary heart disease (APACHE)

Incidence and predictors of serious bleeding during long-term follow-up after acute coronary syndrome in a population-based cohort study

Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy–An observational study

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