Bleeding Risk Following Percutaneous Coronary Intervention in Patients with Diabetes Prescribed Dual Anti-platelet Therapy

• Published in: The American heart journal Vol. 182; pp. 111 - 118
• Main Authors: Grodzinsky, Anna, MD, Arnold, Suzanne V., MD, MHA, Wang, Tracy Y., MD, MSc, Sharma, Praneet, MD, Gosch, Kensey, M.S, Jones, Philip G., M.S, Bhatt, Deepak L., MD, MPH, Steg, Philippe Gabriel, MD, McGuire, Darren K., MD, MHSc, Cohen, David J., MD, MSc, Spertus, John A., MD, MPH, Chhatriwalla, Adnan K., MD, Lind, Marcus, MD, Ph.D, Graham, Garth, MD, MPH, Kosiborod, Mikhail, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2016; Elsevier Limited
• Subjects: Aged; artery-disease; Aspirin - administration & dosage; Aspirin - adverse effects; Blood platelets; Blood transfusions; Cardiovascular; Cardiovascular System & Cardiology; Clinical Medicine; clopidogrel; Comorbidity; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary Artery Disease - therapy; Diabetes; Diabetes Mellitus - epidemiology; Drug Therapy, Combination - adverse effects; Drug Therapy, Combination - methods; Drug Therapy, Combination - statistics & numerical data; Drug-Eluting Stents; Female; Health care access; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Hospitalization; Hospitals; Humans; Interviews; Klinisk medicin; Long Term Adverse Effects - epidemiology; Male; Medicine; mellitus; Middle Aged; myocardial-infarction; outcomes; Patients; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Pharmaceutical industry; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; predictors; Pyridines - administration & dosage; Pyridines - adverse effects; R&D; randomized clinical-trials; Registries - statistics & numerical data; Research & development; restenosis; Risk Assessment; Stents; ticagrelor
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2016.09.010

Background Patients with diabetes (DM) experience higher rates of in-stent restenosis and greater benefit from DES implant at the time of PCI, necessitating prolonged dual anti-platelet therapy (DAPT). While DAPT reduces risk of ischemic events post-PCI, it also increases risk of bleeding. Whether bleeding rates differ among patients with and without DM receiving long-term DAPT is unknown. Methods Among patients who underwent PCI and were maintained on DAPT for 1 year in a multicenter US registry, we assessed patient-reported bleeding over one year following PCI in patients with and without DM. Multivariable, hierarchical Poisson regression was used to evaluate the association of DM with bleeding during follow-up. Results Among 2334 PCI patients from 10 US hospitals (mean age 64, 54% ACS), 32.6% had DM. In unadjusted analyses, patients with DM had fewer bleeding events over the year following PCI (DM vs no DM: BARC =1: 78.0% vs 87.7%, P < .001; BARC ≥2: 4.3% vs 5.3%, P = .33). Following adjustment, patients with (vs. without DM) had a lower risk of BARC ≥1 bleeding during follow-up (relative risk [RR] 0.89, 95% CI 0.83–0.96). This decreased bleeding risk persisted after removing bruising from the endpoint definition. Conclusions In a real-world PCI registry, patients with DM experienced lower risk of bleeding risk on DAPT. As patients with DM also derive greater ischemic benefit from DES, which requires prolonged DAPT, our findings suggest that the balance between benefit and risk of this therapeutic approach may be even more favorable in patients with DM than previously considered.