Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors
Background The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome. Methods and R...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013679 |
| _version_ | 1818398686973001728 |
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| author | Nafiu Ismail Kelvin P. Jordan Umesh T. Kadam John J. Edwards Tim Kinnaird Mamas A. Mamas |
| author_facet | Nafiu Ismail Kelvin P. Jordan Umesh T. Kadam John J. Edwards Tim Kinnaird Mamas A. Mamas |
| author_sort | Nafiu Ismail |
| collection | DOAJ |
| description | Background The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome. Methods and Results We used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person‐years (95% CI, 157–167/1000 person‐years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event. Conclusions Bleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk‐benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy. |
| first_indexed | 2024-12-14T07:08:44Z |
| format | Article |
| id | doaj.art-2ecb0f15a1ae4b129ff88688dfb8c993 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T07:08:44Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-2ecb0f15a1ae4b129ff88688dfb8c9932022-12-21T23:12:03ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182110.1161/JAHA.119.013679Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and PredictorsNafiu Ismail0Kelvin P. Jordan1Umesh T. Kadam2John J. Edwards3Tim Kinnaird4Mamas A. Mamas5Centre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United KingdomCentre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United KingdomDepartment of Health Sciences University of Leicester Leicester United KingdomCentre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United KingdomDepartment of Cardiology University Hospital of Wales Cardiff Wales United KingdomCentre for Prognosis Research Research Institute for Primary Care and Health Sciences Keele University Staffordshire United KingdomBackground The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real‐world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome. Methods and Results We used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person‐years (95% CI, 157–167/1000 person‐years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event. Conclusions Bleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk‐benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy.https://www.ahajournals.org/doi/10.1161/JAHA.119.013679hemorrhageincidencepostdischargereal worldrisk factorssites |
| spellingShingle | Nafiu Ismail Kelvin P. Jordan Umesh T. Kadam John J. Edwards Tim Kinnaird Mamas A. Mamas Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease hemorrhage incidence postdischarge real world risk factors sites |
| title | Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors |
| title_full | Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors |
| title_fullStr | Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors |
| title_full_unstemmed | Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors |
| title_short | Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors |
| title_sort | bleeding after hospital discharge following acute coronary syndrome incidence types timing and predictors |
| topic | hemorrhage incidence postdischarge real world risk factors sites |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013679 |
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