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The Capital Region of Denmark - a part of Copenhagen University Hospital
E-pub ahead of print

Antithrombotic treatment and major adverse cardiac events after bleeding in patients with myocardial infarction: a retrospective analysis of nationwide registry data

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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 (ischemic 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 antitrombotic treatment, 1301 (39.2%) reduced, 164 (4.9%) intensified, and 807 (24.3%) no treatment. MACE occurred in 637 (19.2%) patients. With dual antiplatelet therapy (DAPT) 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), no treatment 1.93 (1.11-3.36).

CONCLUSIONS: 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.

Original languageEnglish
JournalEuropean heart journal. Cardiovascular pharmacotherapy
ISSN2055-6837
DOIs
Publication statusE-pub ahead of print - 5 Jul 2019

ID: 57549401