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Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.

Publication ,  Journal Article
Wang, TY; Xiao, L; Alexander, KP; Rao, SV; Kosiborod, MN; Rumsfeld, JS; Spertus, JA; Peterson, ED
Published in: Circulation
November 18, 2008

BACKGROUND: Bleeding among patients with acute myocardial infarction (AMI) is associated with worse long-term outcomes. Although the mechanism underlying this association is unclear, a potential explanation is that withholding antiplatelet therapies long beyond resolution of the bleeding event may contribute to recurrent events. METHODS AND RESULTS: We examined medication use at discharge, 1, 6, and 12 months after AMI among 2498 patients in the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) registry. Bleeding was defined as non-coronary artery bypass graft-related Thrombolysis of Myocardial Infarction major/minor bleeding or transfusion among patients with baseline hematocrit > or =28%. Logistic regression was used to evaluate the association between bleeding during the index AMI hospitalization and medication use. In-hospital bleeding occurred in 301 patients (12%) with AMI. Patients with in-hospital bleeding were less likely to be discharged on aspirin or thienopyridine (adjusted odds ratio=0.45; 95% CI, 0.31 to 0.64; and odds ratio=0.62; 95% CI, 0.42 to 0.91, respectively). At 1 month after discharge, although patients with in-hospital bleeding remained significantly less likely to receive aspirin (odds ratio=0.68; 95% CI, 0.50 to 0.92), use of thienopyridines in the 2 groups started to become similar. By 1 year, antiplatelet therapy use was similar among patients with and without bleeding. Postdischarge cardiology follow-up was associated with greater antiplatelet therapy use than either primary care or no clinical follow-up. CONCLUSIONS: Patients whose index AMI is complicated by bleeding are less likely to be treated with antiplatelet therapies during the first 6 months after discharge. Early reassessment of antiplatelet eligibility may represent an opportunity to reduce the long-term risk of adverse outcomes associated with bleeding.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 18, 2008

Volume

118

Issue

21

Start / End Page

2139 / 2145

Location

United States

Related Subject Headings

  • Regression Analysis
  • Registries
  • Pyridines
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitals
  • Hemorrhage
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, T. Y., Xiao, L., Alexander, K. P., Rao, S. V., Kosiborod, M. N., Rumsfeld, J. S., … Peterson, E. D. (2008). Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding. Circulation, 118(21), 2139–2145. https://doi.org/10.1161/CIRCULATIONAHA.108.787143
Wang, Tracy Y., Lan Xiao, Karen P. Alexander, Sunil V. Rao, Mikhail N. Kosiborod, John S. Rumsfeld, John A. Spertus, and Eric D. Peterson. “Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.Circulation 118, no. 21 (November 18, 2008): 2139–45. https://doi.org/10.1161/CIRCULATIONAHA.108.787143.
Wang TY, Xiao L, Alexander KP, Rao SV, Kosiborod MN, Rumsfeld JS, et al. Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding. Circulation. 2008 Nov 18;118(21):2139–45.
Wang, Tracy Y., et al. “Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.Circulation, vol. 118, no. 21, Nov. 2008, pp. 2139–45. Pubmed, doi:10.1161/CIRCULATIONAHA.108.787143.
Wang TY, Xiao L, Alexander KP, Rao SV, Kosiborod MN, Rumsfeld JS, Spertus JA, Peterson ED. Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding. Circulation. 2008 Nov 18;118(21):2139–2145.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

November 18, 2008

Volume

118

Issue

21

Start / End Page

2139 / 2145

Location

United States

Related Subject Headings

  • Regression Analysis
  • Registries
  • Pyridines
  • Platelet Aggregation Inhibitors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Hospitals
  • Hemorrhage