Risk of bleeding after hospitalization for a serious coronary event: a retrospective cohort study with nested case-control analysesReportar como inadecuado




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BMC Cardiovascular Disorders

, 16:164

Coronary artery disease

Abstract

BackgroundBleeding 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.

MethodsA 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.

ResultsIncidences 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.

ConclusionsIn 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.

KeywordsAcetylsalicylic acid Bleeding Clopidogrel Coronary event Dual antiplatelet therapy AbbreviationsASAAcetylsalicylic acid

CIConfidence interval

HRHazard ratio

LGIBLower gastrointestinal bleeding

NSAIDNon-steroidal anti-inflammatory drug

OROdds ratio

OTCOver-the-counter

PCPPrimary care physicians

PPIProton pump inhibitors

RRRelative risk

THINThe health improvement network

UGIBUpper gastrointestinal bleeding

Electronic supplementary materialThe online version of this article doi:10.1186-s12872-016-0348-6 contains supplementary material, which is available to authorized users.

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Autor: Antonio González-Pérez - María E. Sáez - Saga Johansson - Anders Himmelmann - Luis A. García Rodríguez

Fuente: https://link.springer.com/







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