Coronary artery disease
Rate of Nuisance Bleedings and Impact on Compliance to Prasugrel in Acute Coronary Syndromes

https://doi.org/10.1016/j.amjcard.2011.07.038Get rights and content

Antiplatelet agents are critical to prevent thrombotic events in patients with acute coronary syndromes, particularly those who undergo percutaneous coronary intervention. Prasugrel is a potent P2Y12–adenosine diphosphate receptor antagonist that is superior to clopidogrel in such patients. Previous studies have observed that nuisance and internal bleedings were relatively frequent in patients under clopidogrel therapy and were associated with noncompliance. Furthermore, premature drug discontinuation is associated with thrombotic recurrences. The aim of the present study was to investigate the rate of nuisance or internal bleedings in patients receiving prasugrel and its relation with compliance. This prospective multicenter study included 396 patients. Bleeding events were recorded and classified as alarming, nuisance, or internal according. Compliance with prasugrel therapy was assessed. Almost half of the patients (48.5%) were included for ST-segment elevation acute coronary syndromes. During the 1-month follow-up period, 54 patients (13.6%) had bleeding events. Most bleeding events were classified as internal or nuisance (96%). Internal and nuisance bleedings were associated with high rates of prasugrel discontinuation (16.6% and 14.7%, respectively). Nuisance and internal bleedings were significantly associated with prasugrel discontinuation in multivariate analysis (odds ratio 3.1, 95% confidence interval 1.01 to 9.2, p = 0.04). The rate of major adverse cardiovascular events was 2.3%. No relation was observed between minor bleeds, compliance, and major adverse cardiovascular events. In conclusion, in the present study, minor bleedings were common during the first month after percutaneous coronary intervention and were significantly associated with prasugrel withdrawal.

Section snippets

Methods

This was a multicenter prospective study. The study cohort consisted of patients who underwent successful stent implantation for acute coronary syndromes and received prasugrel for ≥1 month. All patients gave written consent before entering the study. The protocol was approved by the local ethics committee and in accordance with the Declaration of Helsinki.

PCI was performed using a standard technique through a femoral or a radial approach. All patients were treated with aspirin 250 mg before

Results

Baseline characteristics of patients are summarized in Table 1. The study population was composed of 396 patients who received prasugrel therapy for acute coronary syndromes. No patient underwent coronary artery bypass surgery. During the 1-month follow-up period, 54 patients (13.6%), had bleeding events, including alarming bleeding in 2 (3.7%), internal bleeding in 18 (33.3%), and nuisance bleeding in 34 (63%).

Among patients with bleeding, 52 (96%) had minor bleedings, either nuisance or

Discussion

In the present study, nuisance or internal minor bleedings were common during the first month after PCI in patients receiving prasugrel. Of importance, these minor bleeds were significantly associated with prasugrel discontinuation.

In fact, a large part of the study cohort (13.6%) had minor bleedings, defined as nuisance or internal bleeding, which includes bleeds from small cuts, ecchymosis, or epistaxis.5, 10 Such a high rate of minor bleeds under prasugrel is probably related to its strong

References (20)

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This work was supported by an institutional grant from Assistance Publique – Hôpitaux de Marseille, Marseille, France.

Drs. Armero and Bonello contributed equally to this study.

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