Decreased Serum Albumin Predicts Bleeding Events in Patients on Antiplatelet Therapy After Percutaneous Coronary Intervention

• Published in: Circulation Journal Vol. 81; no. 7; pp. 999 - 1005
• Main Authors: Tatami, Yosuke, Ishii, Hideki, Aoki, Toshijiro, Harada, Kazuhiro, Hirayama, Kenshi, Shibata, Yohei, Sumi, Takuya, Negishi, Yosuke, Kawashima, Kazuhiro, Kunimura, Ayako, Kawamiya, Toshiki, Yamamoto, Dai, Suzuki, Susumu, Murohara, Toyoaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2017
• Subjects: Aged; Aged, 80 and over; Albumin; Antiplatelet therapy; Aspirin - administration & dosage; Aspirin - adverse effects; Bleeding event; Female; Humans; Male; Middle Aged; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Postoperative Hemorrhage - blood; Postoperative Hemorrhage - epidemiology; Postoperative Hemorrhage - etiology; Pyridines - administration & dosage; Pyridines - adverse effects; Risk Factors; Serum Albumin, Human - metabolism; Time Factors; Antiplatelet therapy; Albumin; Bleeding event; Percutaneous coronary intervention
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0015

Background:Antiplatelet therapy (APT) after percutaneous coronary intervention (PCI) prevents ischemic events with increased risk of bleeding. Little is known about the relationship between hypoalbuminemia and bleeding risk in patients receiving APT after PCI. This study investigated the association between serum albumin level and bleeding events in this population.Methods and Results:We enrolled 438 consecutive patients who were prescribed dual APT (DAPT; aspirin and thienopyridine) beyond 1 month after successful PCI without adverse events. The patients were divided into 3 groups according to serum albumin tertile: tertile 1, ≤3.7 g/dL; tertile 2, 3.8–4.1 g/dL; and tertile 3, ≥4.2 g/dL. Adverse bleeding events were defined as Bleeding Academic Research Consortium criteria types 2, 3, and 5. During the median follow-up of 29.5 months, a total of 30 adverse bleeding events were observed. Median duration of DAPT was 14 months. The tertile 1 group had the highest risk of adverse bleeding events (event-free rate, 83.1%, 94.3% and 95.8%, respectively; P<0.001). On Cox proportional hazards modeling, serum albumin independently predicted adverse bleeding events (HR, 0.10, 95% CI: 0.027–0.39, P=0.001, for tertile 3 vs. tertile 1).Conclusions:Decreased serum albumin predicted bleeding events in patients with APT after PCI.