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. 2014 Oct 16:5:57-62.
doi: 10.1016/j.ijcha.2014.10.007. eCollection 2014 Dec.

Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation

Vassilis Voudris  1 , Panagiotis Karyofyllis  1 , Constantinos Doulaptsis  1 , Ioannis Moukas  1 , Sofia Thomopoulou  1 , Denis V Cokkinos  1
Affiliations

Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation

Vassilis Voudris et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment persist due to increased risk of bleeding. In this study are assessed the incidence, correlates, and clinical significance of bleeding complications in diabetic patients after long-term DAPLT post DES implantation.

Methods: We studied 610 consecutive diabetic patients after DES implantation. The primary end point was the occurrence of any bleeding according to the BARC and TIMI definitions.

Results: The incidence of overall bleeding was higher in patients on DAPLT (21.1% vs. 4.4%, p < 0.001); minor/minimal according to the TIMI definition, and type 1 or 2 according to the BARC definition, were more frequently observed in patients on DAPLT (20.3% vs. 3.0%, p < 0.001, 15.6% vs. 2.0%, p < 0.001 and 4.4% vs. 0.5%, p = 0.034, respectively), whereas there was no effect on type 3 (3.5% vs. 2.0%, p = ns). DAPLT was an independent predictor for overall (HR 5.35, 95% CI: 2.69-10.67, p < 0.001), minor (HR 7.45, 95% CI: 3.25-17.12, p < 0.001, for TIMI classification) and type 1 or 2 bleeding (HR 8.17, 95% CI 3.29-20.25, p < 0.001); furthermore smoking was also predictor for overall bleeding (HR 1.65, 95% CI: 1.05-2.61, p = 0.030). Cardiovascular adverse events were not more frequent in patients with bleeding as compared with those without bleeding.

Conclusions: Long-term DAPLT in diabetic patients after DES implantation is associated with higher risk of overall and minor but not major bleeding; smoking may have a significant role in the occurrence of bleeding complications.

Keywords: Antiplatelet therapy; Bleeding; Coronary artery disease; Diabetes mellitus; Drug eluting stents.

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Figures

Fig. 1
Fig. 1
Cumulative bleeding free rates during the follow-up period. Cumulative bleeding-free rate for the first year was 98.0% (SE = 0.6%), for two years 95.3% (SE = 0.9%) and for five years 89.4% (SE = 1.3%).
Fig. 2
Fig. 2
Cumulative hazard of bleeding for patients on DAPLT vs. SAPLT treatment. Patients on DAPLT had greater hazard for bleeding complication. DAPLT: dual antiplatelet treatment, SAPLT: single antiplatelet treatment.
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