Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation
Background: Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment persist due to increased risk of bleeding. In this study are assessed the incidence, correlates, and clinical s...
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| Format: | Article |
| Language: | English |
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Elsevier
2014-12-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906714000748 |
| _version_ | 1819171693280624640 |
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| author | Vassilis Voudris Panagiotis Karyofyllis Constantinos Doulaptsis Ioannis Moukas Sofia Thomopoulou Denis V. Cokkinos |
| author_facet | Vassilis Voudris Panagiotis Karyofyllis Constantinos Doulaptsis Ioannis Moukas Sofia Thomopoulou Denis V. Cokkinos |
| author_sort | Vassilis Voudris |
| collection | DOAJ |
| description | Background: Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment persist due to increased risk of bleeding. In this study are assessed the incidence, correlates, and clinical significance of bleeding complications in diabetic patients after long-term DAPLT post DES implantation.
Methods: We studied 610 consecutive diabetic patients after DES implantation. The primary end point was the occurrence of any bleeding according to the BARC and TIMI definitions.
Results: The incidence of overall bleeding was higher in patients on DAPLT (21.1% vs. 4.4%, p < 0.001); minor/minimal according to the TIMI definition, and type 1 or 2 according to the BARC definition, were more frequently observed in patients on DAPLT (20.3% vs. 3.0%, p < 0.001, 15.6% vs. 2.0%, p < 0.001 and 4.4% vs. 0.5%, p = 0.034, respectively), whereas there was no effect on type 3 (3.5% vs. 2.0%, p = ns). DAPLT was an independent predictor for overall (HR 5.35, 95% CI: 2.69–10.67, p < 0.001), minor (HR 7.45, 95% CI: 3.25–17.12, p < 0.001, for TIMI classification) and type 1 or 2 bleeding (HR 8.17, 95% CI 3.29–20.25, p < 0.001); furthermore smoking was also predictor for overall bleeding (HR 1.65, 95% CI: 1.05–2.61, p = 0.030). Cardiovascular adverse events were not more frequent in patients with bleeding as compared with those without bleeding.
Conclusions: Long-term DAPLT in diabetic patients after DES implantation is associated with higher risk of overall and minor but not major bleeding; smoking may have a significant role in the occurrence of bleeding complications. |
| first_indexed | 2024-12-22T19:55:20Z |
| format | Article |
| id | doaj.art-7734f133dd224388ad3ef7fba127d9e2 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-22T19:55:20Z |
| publishDate | 2014-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-7734f133dd224388ad3ef7fba127d9e22022-12-21T18:14:26ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672014-12-015C576210.1016/j.ijcha.2014.10.007Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantationVassilis VoudrisPanagiotis KaryofyllisConstantinos DoulaptsisIoannis MoukasSofia ThomopoulouDenis V. CokkinosBackground: Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment persist due to increased risk of bleeding. In this study are assessed the incidence, correlates, and clinical significance of bleeding complications in diabetic patients after long-term DAPLT post DES implantation. Methods: We studied 610 consecutive diabetic patients after DES implantation. The primary end point was the occurrence of any bleeding according to the BARC and TIMI definitions. Results: The incidence of overall bleeding was higher in patients on DAPLT (21.1% vs. 4.4%, p < 0.001); minor/minimal according to the TIMI definition, and type 1 or 2 according to the BARC definition, were more frequently observed in patients on DAPLT (20.3% vs. 3.0%, p < 0.001, 15.6% vs. 2.0%, p < 0.001 and 4.4% vs. 0.5%, p = 0.034, respectively), whereas there was no effect on type 3 (3.5% vs. 2.0%, p = ns). DAPLT was an independent predictor for overall (HR 5.35, 95% CI: 2.69–10.67, p < 0.001), minor (HR 7.45, 95% CI: 3.25–17.12, p < 0.001, for TIMI classification) and type 1 or 2 bleeding (HR 8.17, 95% CI 3.29–20.25, p < 0.001); furthermore smoking was also predictor for overall bleeding (HR 1.65, 95% CI: 1.05–2.61, p = 0.030). Cardiovascular adverse events were not more frequent in patients with bleeding as compared with those without bleeding. Conclusions: Long-term DAPLT in diabetic patients after DES implantation is associated with higher risk of overall and minor but not major bleeding; smoking may have a significant role in the occurrence of bleeding complications.http://www.sciencedirect.com/science/article/pii/S2352906714000748Coronary artery diseaseBleedingDrug eluting stentsDiabetes mellitusAntiplatelet therapy |
| spellingShingle | Vassilis Voudris Panagiotis Karyofyllis Constantinos Doulaptsis Ioannis Moukas Sofia Thomopoulou Denis V. Cokkinos Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation International Journal of Cardiology: Heart & Vasculature Coronary artery disease Bleeding Drug eluting stents Diabetes mellitus Antiplatelet therapy |
| title | Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| title_full | Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| title_fullStr | Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| title_full_unstemmed | Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| title_short | Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| title_sort | long term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation |
| topic | Coronary artery disease Bleeding Drug eluting stents Diabetes mellitus Antiplatelet therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2352906714000748 |
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