Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients
Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with ac...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cell Physiol Biochem Press GmbH & Co KG
2018-10-01
|
| Series: | Cellular Physiology and Biochemistry |
| Subjects: | |
| Online Access: | https://www.karger.com/Article/FullText/494543 |
| _version_ | 1818911309303906304 |
|---|---|
| author | Jindong Wan Peijian Wang Peng Zhou Sen Liu Dan Wang Jingyu Kan Jixin Hou Li Zuo Shuangtao Ma Yongjian Yang |
| author_facet | Jindong Wan Peijian Wang Peng Zhou Sen Liu Dan Wang Jingyu Kan Jixin Hou Li Zuo Shuangtao Ma Yongjian Yang |
| author_sort | Jindong Wan |
| collection | DOAJ |
| description | Background/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population. |
| first_indexed | 2024-12-19T22:56:39Z |
| format | Article |
| id | doaj.art-29c4a058b54f463282cda3784045ad5a |
| institution | Directory Open Access Journal |
| issn | 1015-8987 1421-9778 |
| language | English |
| last_indexed | 2024-12-19T22:56:39Z |
| publishDate | 2018-10-01 |
| publisher | Cell Physiol Biochem Press GmbH & Co KG |
| record_format | Article |
| series | Cellular Physiology and Biochemistry |
| spelling | doaj.art-29c4a058b54f463282cda3784045ad5a2022-12-21T20:02:38ZengCell Physiol Biochem Press GmbH & Co KGCellular Physiology and Biochemistry1015-89871421-97782018-10-015031164117710.1159/000494543494543Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly PatientsJindong WanPeijian WangPeng ZhouSen LiuDan WangJingyu KanJixin HouLi ZuoShuangtao MaYongjian YangBackground/Aims: Bleeding complications after percutaneous coronary intervention (PCI) are strongly associated with adverse patient outcomes. However, there are no specific guidelines for the predictors and management of antiplatelet-related bleeding complications in Chinese elderly patients with acute coronary syndrome (ACS). Methods: A retrospective analysis of 237 consecutive patients (aged ≥ 75 years) with ACS who had undergone successful PCI from January 2010 to December 2016 was performed to identify predictors and management of antiplatelet-related bleeding complications. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. We defined antiplatelet-related bleeding complications as first hospitalization received long-term oral antiplatelet therapy and required hospitalization, including gastrointestinal and intracranial bleedings. Results: After multivariable adjustment, independent risk predictors of antiplatelet-related bleeding complications included female gender (odds ratio [OR]: 2.96; 95% confidence interval [CI]: 1.98 to 4.15; P = 0.011), body mass index (OR: 1.54; 95% CI: 1.06 to 1.94; P = 0.034), previous history of bleeding (OR: 4.03; 95% CI: 1.84 to 6.12; P = 0.004), fasting blood glucose (OR: 2.79; 95% CI: 1.23 to 4.46; P = 0.025), and chronic total occlusion lesion (OR: 4.69; 95% CI: 2.19 to 7.93; P = 0.007). Of 46 patients with antiplatelet-related bleeding complications, 54.3% were treated short-term dual antiplatelet therapy (DAPT) cessation (0–7 days) and 45.7% underwent long-term DAPT cessation (> 7 days). Among these, 14 patients presented major adverse cardiac and cerebrovascular events (MACCE), whereas no re-bleeding happened over all available follow-up. The incidence of MACCE was not significantly different between the two groups one year after PCI (36.0% for short-term DAPT cessation versus 23.8% for long-term DAPT cessation, P = 0.522). Conclusion: For elderly patients with ACS, multiple factors were likely to contribute to antiplatelet-related bleeding complications, especially previous history of bleeding and chronic total occlusion lesion. Better individualized, tailored and risk-adjusted antiplatelet therapy after PCI is urgently needed in this high-risk population.https://www.karger.com/Article/FullText/494543BleedingAntiplatelet therapyAcute coronary syndromeMajor adverse cardiac and cerebrovascular events |
| spellingShingle | Jindong Wan Peijian Wang Peng Zhou Sen Liu Dan Wang Jingyu Kan Jixin Hou Li Zuo Shuangtao Ma Yongjian Yang Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients Cellular Physiology and Biochemistry Bleeding Antiplatelet therapy Acute coronary syndrome Major adverse cardiac and cerebrovascular events |
| title | Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients |
| title_full | Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients |
| title_fullStr | Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients |
| title_full_unstemmed | Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients |
| title_short | Predictors and Management of Antiplatelet-Related Bleeding Complications for Acute Coronary Syndrome in Chinese Elderly Patients |
| title_sort | predictors and management of antiplatelet related bleeding complications for acute coronary syndrome in chinese elderly patients |
| topic | Bleeding Antiplatelet therapy Acute coronary syndrome Major adverse cardiac and cerebrovascular events |
| url | https://www.karger.com/Article/FullText/494543 |
| work_keys_str_mv | AT jindongwan predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT peijianwang predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT pengzhou predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT senliu predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT danwang predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT jingyukan predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT jixinhou predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT lizuo predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT shuangtaoma predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients AT yongjianyang predictorsandmanagementofantiplateletrelatedbleedingcomplicationsforacutecoronarysyndromeinchineseelderlypatients |