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Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial
Duke Univ, Duke Clin Res Inst, Sch Med, Durham, NC USA;McGill Univ, Div Cardiol, Hlth Ctr, Montreal, PQ, Canada;Stanford Univ, Div Cardiol, Stanford Sch Med, Stanford, CA 94305 USA.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Duke Univ, Duke Clin Res Inst, Sch Med, Durham, NC USA.
Duke Univ, Duke Clin Res Inst, Sch Med, Durham, NC USA.
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2019 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 215, p. 106-113Article in journal (Refereed) Published
Abstract [en]

Background Patients with a recent acute coronary syndrome (ACS) receiving oral antiplatelets and anticoagulants are at risk for bleeding and subsequent adverse non-bleeding-related events. Methods In this post hoc analysis, we evaluated 7,392 high-risk patients (median follow-up 241 days) with a recent ACS randomized to apixaban or placebo in APPRAISE-2. Clinical events during a 30-day period after Thrombolysis in Myocardial Infarction (TIMI) major/minor bleeding were analyzed using unadjusted and adjusted Cox proportional-hazards models. Results In total, 153 (2.1%) patients experienced TIMI major/minor bleeding during follow-up. Bleeding risk for patients on triple therapy (apixaban, thienopyridine, and aspirin) was increased compared with those on dual therapy (apixaban plus aspirin: hazard ratio [HR] 2.02, 95% CI 1.08-3.79; thienopyridine plus aspirin: HR 1.99, 95% CI 1.41-2.83). Those receiving apixaban/aspirin had similar bleeding risk compared with those receiving thienopyridine/aspirin (HR 1.01, 95% CI 0.53-1.95). Patients who experienced TIMI major/minor bleeding had an increased risk of 30-day all-cause mortality (HR 24.7, 95% CI 15.34-39.66) and ischemic events (HR 6.7, 95% CI 3.14-14.14). Conclusions In a contemporary cohort of high-risk patients after ACS, bleeding was associated with a significantly increased risk of subsequent ischemic events and mortality regardless of antithrombotic or anticoagulant strategy. Patients receiving apixaban plus aspirin had a similar bleeding risk compared with those receiving thienopyridine plus aspirin. Interventions to improve outcomes in patients after ACS should include strategies to optimize the reduction in ischemic events while minimizing the risk of bleeding.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER , 2019. Vol. 215, p. 106-113
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Cardiac and Cardiovascular Systems
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URN: urn:nbn:se:uu:diva-393326DOI: 10.1016/j.ahj.2019.05.004ISI: 000478778600013PubMedID: 31310855OAI: oai:DiVA.org:uu-393326DiVA, id: diva2:1355375
Available from: 2019-09-27 Created: 2019-09-27 Last updated: 2019-09-27Bibliographically approved

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Hagström, EmilWallentin, Lars

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