Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status

Amit P. Amin, Alok Bachuwar, Kimberly J. Reid, Adnan K. Chhatriwalla, Adam C. Salisbury, Robert W. Yeh, Mikhail Kosiborod, Tracy Y. Wang, Karen P. Alexander, Kensey Gosch, David J. Cohen, John A. Spertus, Richard G. Bach

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Abstract

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.

Original languageEnglish
Pages (from-to)2130-2138
Number of pages9
JournalJournal of the American College of Cardiology
Volume61
Issue number21
DOIs
StatePublished - May 28 2013

Keywords

  • EuroQOL
  • clopidogrel
  • dual antiplatelet therapy
  • nuisance bleeding
  • quality of life

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    Amin, A. P., Bachuwar, A., Reid, K. J., Chhatriwalla, A. K., Salisbury, A. C., Yeh, R. W., Kosiborod, M., Wang, T. Y., Alexander, K. P., Gosch, K., Cohen, D. J., Spertus, J. A., & Bach, R. G. (2013). Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status. Journal of the American College of Cardiology, 61(21), 2130-2138. https://doi.org/10.1016/j.jacc.2013.02.044