| Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding. | |
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MedLine Citation:
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PMID: 18981304 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Tracy Y Wang; Lan Xiao; Karen P Alexander; Sunil V Rao; Mikhail N Kosiborod; John S Rumsfeld; John A Spertus; Eric D Peterson |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-11-03 |
Journal Detail:
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Title: Circulation Volume: 118 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-11-18 Completed Date: 2008-12-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2139-45 Citation Subset: AIM; IM |
Affiliation:
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Duke Clinical Research Institute, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705, USA. wang0085@mc.duke.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Aspirin / administration & dosage, adverse effects* Female Follow-Up Studies Hematocrit Hemorrhage / chemically induced* Hospitals Humans Male Middle Aged Myocardial Infarction / therapy* Platelet Aggregation Inhibitors / administration & dosage, adverse effects* Pyridines / administration & dosage, adverse effects* Registries* Regression Analysis |
| Chemical | |
Reg. No./Substance:
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0/Platelet Aggregation Inhibitors; 0/Pyridines; 0/thienopyridine; 50-78-2/Aspirin |
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