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Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial.

Publication ,  Journal Article
Sharma, A; Hagström, E; Wojdyla, DM; Neely, ML; Harrington, RA; Wallentin, L; Alexander, JH; Goodman, SG; Lopes, RD ...
Published in: Am Heart J
September 2019

UNLABELLED: 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.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2019

Volume

215

Start / End Page

106 / 113

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Pyridones
  • Pyridines
  • Pyrazoles
  • Proportional Hazards Models
  • Platelet Aggregation Inhibitors
  • Outcome and Process Assessment, Health Care
  • Myocardial Infarction
 

Citation

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MLA
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Sharma, A., Hagström, E., Wojdyla, D. M., Neely, M. L., Harrington, R. A., Wallentin, L., … Apixaban for Prevention of Acute Ischemic Safety Events APPRAISE-2 Steering Committee and Investigators, . (2019). Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial. Am Heart J, 215, 106–113. https://doi.org/10.1016/j.ahj.2019.05.004
Sharma, Abhinav, Emil Hagström, Daniel M. Wojdyla, Megan L. Neely, Robert A. Harrington, Lars Wallentin, John H. Alexander, Shaun G. Goodman, Renato D. Lopes, and Renato D. Apixaban for Prevention of Acute Ischemic Safety Events APPRAISE-2 Steering Committee and Investigators. “Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial.Am Heart J 215 (September 2019): 106–13. https://doi.org/10.1016/j.ahj.2019.05.004.
Sharma A, Hagström E, Wojdyla DM, Neely ML, Harrington RA, Wallentin L, et al. Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial. Am Heart J. 2019 Sep;215:106–13.
Sharma, Abhinav, et al. “Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial.Am Heart J, vol. 215, Sept. 2019, pp. 106–13. Pubmed, doi:10.1016/j.ahj.2019.05.004.
Sharma A, Hagström E, Wojdyla DM, Neely ML, Harrington RA, Wallentin L, Alexander JH, Goodman SG, Lopes RD, Apixaban for Prevention of Acute Ischemic Safety Events APPRAISE-2 Steering Committee and Investigators. Clinical consequences of bleeding among individuals with a recent acute coronary syndrome: Insights from the APPRAISE-2 trial. Am Heart J. 2019 Sep;215:106–113.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2019

Volume

215

Start / End Page

106 / 113

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Pyridones
  • Pyridines
  • Pyrazoles
  • Proportional Hazards Models
  • Platelet Aggregation Inhibitors
  • Outcome and Process Assessment, Health Care
  • Myocardial Infarction