Document Detail


Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.
MedLine Citation:
PMID:  18981304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-11-03
Journal Detail:
Title:  Circulation     Volume:  118     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-18     Completed Date:  2008-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2139-45     Citation Subset:  AIM; IM    
Affiliation:
Duke Clinical Research Institute, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705, USA. wang0085@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
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:
0/Platelet Aggregation Inhibitors; 0/Pyridines; 0/thienopyridine; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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