Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Mar 25;16(3):e0248359.
doi: 10.1371/journal.pone.0248359. eCollection 2021.

Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy-An observational study

Anna Holm  1 , Martin Henriksson  2 , Joakim Alfredsson  1 , Magnus Janzon  1 , Therese Johansson  2 , Eva Swahn  1 , Dominique Vial  2 , Sofia Sederholm Lawesson  1
Affiliations
Observational Study

Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy-An observational study

Anna Holm et al. PLoS One. .

Abstract

Objectives: Bleeding is the most common non-ischemic complication in patients with coronary revascularisation procedures, associated with prolonged hospitalisation and increased mortality. Many factors predispose for bleeds in these patients, among those sex. Anyhow, few studies have characterised the population receiving triple antithrombotic therapy (TAT) as well as long term bleeds from a sex perspective. We investigated the one year rate of bleeds in patients receiving TAT, potential sex disparities and premature discontinuation of TAT. We also assessed health care costs in bleeders vs non-bleeders.

Setting: Three hospitals in the County of Östergötland, Sweden during 2009-2015.

Participants: All patients discharged with TAT registered in the SWEDEHEART registry.

Primary and secondary outcome measures: All bleeds receiving medical attention during one-year follow-up were collected by retrieving relevant information about each patient from medical records. Resource use associated with bleeds was assigned unit cost to estimate the health care costs associated with bleeding episodes.

Results: Among 272 patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p = 0.01) and bled more (48.6 vs. 37.1%, p = 0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively.

Conclusion: The high bleeding incidence in patients with TAT, especially in women, is a cause of concern. There is a need for an adequately sized randomised, controlled trial to determine a safe but still effective treatment for these patients.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Long term risk of bleeding in patients discharged with triple antithrombotic therapy.
Log rank test men vs women 0.09.
See this image and copyright information in PMC

References

    1. Manoukian SV. Predictors and impact of bleeding complications in percutaneous coronary intervention, acute coronary syndromes, and ST-segment elevation myocardial infarction. Am J Cardiol. 2009;104(5 Suppl):9C–15C. 10.1016/j.amjcard.2009.06.020 - DOI - PubMed
    1. Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114(8):774–82. 10.1161/CIRCULATIONAHA.106.612812 - DOI - PubMed
    1. Rao SV, O’Grady K, Pieper KS, Granger CB, Newby LK, Van de Werf F, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol. 2005;96(9):1200–6. 10.1016/j.amjcard.2005.06.056 - DOI - PubMed
    1. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15. 10.1056/NEJMoa0706482 - DOI - PubMed
    1. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. The New England journal of medicine. 2009;361(11):1045–57. 10.1056/NEJMoa0904327 - DOI - PubMed

Publication types

Substances