Antithrombotic treatment and major adverse cardiac events after bleeding in patients with myocardial infarction: a retrospective analysis of nationwide registry data. Issue 1 (5th July 2019)

• Record Type: Journal Article
• Authors: Nabi, Hafsah; Rørth, Rasmus; Tajchman, Daniel H; Holmvang, Lene; Torp-Pedersen, Christian; Gislason, Gunnar; Fosbøl, Emil L; Køber, Lars; Sørensen, Rikke
• Is Part Of: European heart journal. Volume 6:Issue 1(2020)
• Page Start: 14
• Page End: 21
• Publication Date: 2019-07-05
• Subjects: Myocardial infarction -- Bleeding -- Antithrombotic treatment; Cardiovascular pharmacology -- Periodicals; 615.71
• DOI: 10.1093/ehjcvp/pvz025
• Languages: English
• ISSNs: 2055-6837

Abstract

Abstract: Aims: The aim of this study was to describe the use of antithrombotic therapy following a bleeding event among patients with myocardial infarction (MI), and the associated risk of major adverse cardiac events (MACE). Methods and results: Using Danish nationwide registries, patients hospitalized with a bleeding event within 1 year after MI were identified. Antithrombotic treatment with aspirin, clopidogrel, and/or vitamin K antagonists (VKA) was determined at the bleeding and at Day 90 and 180 post-bleed. Based on guidelines, patients were stratified into four groups: expected, reduced, discontinued, or intensified treatment. Risk of MACE (ischaemic stroke, MI, or death) within the first year was assessed by Cox proportional hazard models. A total of 3324 patients with a bleeding after MI were included. At Day 90 post-bleed, 1052 (31.7%) received expected antithrombotic treatment, 1301 (39.2%) reduced, 164 (4.9%) intensified, and 807 (24.3%) no treatment. Major adverse cardiac events occurred in 637 (19.2%) patients. With dual antiplatelet therapy as reference, adjusted hazard ratios for MACE were: aspirin 1.81 (1.06–3.09), clopidogrel 1.08 (0.64–1.82), VKA 1.08 (0.47–2.48), VKA + aspirin 1.97 (0.95–4.07), VKA + clopidogrel 0.26 (0.03–1.91), triple 1.73 (0.50–5.95), and no treatment 1.93 (1.11–3.36). Conclusion: The majority of MI patients reduced or discontinued their antithrombotic therapy post-bleed. Patients in monotherapy with aspirin or no treatment post-bleed had a higher risk of MACE Further studies of optimal antithrombotic treatments after a bleed are needed.