TY - JOUR
T1 - Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status
AU - Amin, Amit P.
AU - Bachuwar, Alok
AU - Reid, Kimberly J.
AU - Chhatriwalla, Adnan K.
AU - Salisbury, Adam C.
AU - Yeh, Robert W.
AU - Kosiborod, Mikhail
AU - Wang, Tracy Y.
AU - Alexander, Karen P.
AU - Gosch, Kensey
AU - Cohen, David J.
AU - Spertus, John A.
AU - Bach, Richard G.
N1 - Funding Information:
The TRIUMPH study was funded by P50 HL077113 from the National Heart, Lung, and Blood Institute , and support for these analyses was provided by an award from the American Heart Association Pharmaceutical Round Table and David and Stevie Spina. Dr. Amin is funded via a comparative effectiveness research KM1 career development award from the Clinical and Translational Science Award program of the National Center for Advancing Translational Sciences of the National Institutes of Health , Grants UL1TR000448 , KL2TR000450 , and TL1TR000449 , and the National Cancer Institute of the National Institutes of Health , Grant 1KM1CA156708-01 . Dr. Yeh has received research funding from the Harvard Clinical Research Institute. Dr. Kosiborod has received research grant support from Medtronic Minimed , Gilead Sciences , Genentech , Sanofi-Aventis , and GluMetrics Inc. ; and serves as a consultant and is on the advisory board for Medtronic Minimed, Gilead Sciences, Genentech, Boehringer Ingelheim, CardioMEMS, and Hoffmann-La Roche Ltd. Dr. Wang is a consultant for ACCF and Medeo; lectures for AstraZeneca; and has received research grant support from Bristol-Myers Squibb , Daiichi Sankyo , Heartscape Technologies , Eli Lilly & Company , Sanofi-Aventis , Schering Plough/Merck , and Gilead . Dr. Cohen serves as a consultant and is on the advisory board of AstraZeneca and Janssen Pharmaceuticals; has received research grant support from Boston Scientific , Medtronic , Abbott Vascular , Eli Lilly , Daichi Sankyo , Accumetrix , BMS/Sanofi , Schering-Plough , AstraZeneca , and Edwards Lifesciences ; has received consulting fees from Cordis and Medtronic; and has received speaking honoraria from Eli Lilly and The Medicines Company. Dr. Spertus is the Principal Investigator of a contract from the American College of Cardiology Foundation to serve as an Analytic Center for the National Cardiovascular Data Registry; has an equity position in Health Outcomes Sciences; and has served as a consultant to Eli Lilly & Company, United Healthcare, Genentech, Amgen, Abbott Vascular, EvaHeart, and St. Jude Medical. Dr. Bach is a consultant to and a member of the clinical event committee activity to Hoffmann-La Roche Ltd. and Pfizer and has received research support from AstraZeneca, BMS, Eli Lilly & Company, and Schering Plough/Merck. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/5/28
Y1 - 2013/5/28
N2 - Objectives: The purpose of this study was to examine the incidence of nuisance bleeding after AMI and its impact on QOL. Background: Prolonged dual antiplatelet therapy (DAPT) is recommended after acute myocardial infarction (AMI) to reduce ischemic events, but it is associated with increased rates of major and minor bleeding. The incidence of even lesser degrees of post-discharge "nuisance" bleeding with DAPT and its impact on quality of life (QOL) are unknown. Methods: Data from the 24-center TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) study of 3,560 patients, who were interviewed at 1, 6, and 12 months after AMI, were used to investigate the incidence of nuisance bleeding (defined as Bleeding Academic Research Consortium type 1). Baseline characteristics associated with "nuisance" bleeding and its association with QOL, as measured by the EuroQol 5 Dimension visual analog scale, and subsequent re-hospitalization were examined. Results: Nuisance (Bleeding Academic Research Consortium type 1) bleeding occurred in 1,335 patients (37.5%) over the 12 months after AMI. After adjusting for baseline bleeding and mortality risk, ongoing DAPT was the strongest predictor of nuisance bleeding (rate ratio [RR]: 1.44, 95% confidence interval [CI]: 1.17 to 1.76 at 1 month; RR: 1.89, 95% CI: 1.35 to 2.65 at 6 months; and RR: 1.39, 95% CI: 1.08 to 1.79 at 12 months; p < 0.01 for all comparisons). Nuisance bleeding at 1 month was independently associated with a decrement in QOL at 1 month (-2.81 points on EuroQol 5 Dimension visual analog scale; 95% CI: 1.09 to 5.64) and nonsignificantly toward higher re-hospitalization (hazard ratio: 1.20; 95% CI: 0.95 to 1.52). Conclusions: Nuisance bleeding is common in the year after AMI, associated with ongoing use of DAPT, and independently associated with worse QOL. Improved selection of patients for prolonged DAPT may help minimize the incidence and adverse consequences of nuisance bleeding.
AB - Objectives: The purpose of this study was to examine the incidence of nuisance bleeding after AMI and its impact on QOL. Background: Prolonged dual antiplatelet therapy (DAPT) is recommended after acute myocardial infarction (AMI) to reduce ischemic events, but it is associated with increased rates of major and minor bleeding. The incidence of even lesser degrees of post-discharge "nuisance" bleeding with DAPT and its impact on quality of life (QOL) are unknown. Methods: Data from the 24-center TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) study of 3,560 patients, who were interviewed at 1, 6, and 12 months after AMI, were used to investigate the incidence of nuisance bleeding (defined as Bleeding Academic Research Consortium type 1). Baseline characteristics associated with "nuisance" bleeding and its association with QOL, as measured by the EuroQol 5 Dimension visual analog scale, and subsequent re-hospitalization were examined. Results: Nuisance (Bleeding Academic Research Consortium type 1) bleeding occurred in 1,335 patients (37.5%) over the 12 months after AMI. After adjusting for baseline bleeding and mortality risk, ongoing DAPT was the strongest predictor of nuisance bleeding (rate ratio [RR]: 1.44, 95% confidence interval [CI]: 1.17 to 1.76 at 1 month; RR: 1.89, 95% CI: 1.35 to 2.65 at 6 months; and RR: 1.39, 95% CI: 1.08 to 1.79 at 12 months; p < 0.01 for all comparisons). Nuisance bleeding at 1 month was independently associated with a decrement in QOL at 1 month (-2.81 points on EuroQol 5 Dimension visual analog scale; 95% CI: 1.09 to 5.64) and nonsignificantly toward higher re-hospitalization (hazard ratio: 1.20; 95% CI: 0.95 to 1.52). Conclusions: Nuisance bleeding is common in the year after AMI, associated with ongoing use of DAPT, and independently associated with worse QOL. Improved selection of patients for prolonged DAPT may help minimize the incidence and adverse consequences of nuisance bleeding.
KW - EuroQOL
KW - clopidogrel
KW - dual antiplatelet therapy
KW - nuisance bleeding
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=84877975639&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.02.044
DO - 10.1016/j.jacc.2013.02.044
M3 - Article
C2 - 23541975
AN - SCOPUS:84877975639
SN - 0735-1097
VL - 61
SP - 2130
EP - 2138
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -