Coronary artery diseaseRate of Nuisance Bleedings and Impact on Compliance to Prasugrel in Acute Coronary Syndromes
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
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Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study
2018, International Journal of CardiologyCitation Excerpt :These findings emphasize the benefit of intensive secondary prevention strategies to minimize residual risk. The situation is further complicated by decreasing adherence to secondary prevention treatments after discharge from hospital [8–14]. European guidelines advocate immediate reperfusion with primary angioplasty or fibrinolytic therapy for STEMI, and an invasive strategy for NSTEMI patients with moderate-risk to very high-risk characteristics [14, 15].
One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction
2016, Archives of Cardiovascular DiseasesCitation Excerpt :This association between minor bleedings and patient compliance has been described with clopidogrel [23,41,42]. Although very few studies have evaluated prasugrel compliance in everyday practice, small registry studies, such as that published by Armero et al. [43], have confirmed that patients with minor bleedings discontinued prasugrel more often than those without bleeding. The withdrawal of antiplatelet treatment after percutaneous coronary intervention, and particularly after acute coronary syndromes, is detrimental to prognosis [41,44,45], and a high rate of ischaemic events is particularly associated with patient disruption.
Efficacy and safety of prasugrel in acute coronary syndrome patients
2014, Clinical BiochemistryCitation Excerpt :Gastrointestinal hemorrhage [24–26] and peptic ulcer [27] were reported in other studies. Minor bleeding events, defined by Armero et al. as nuisance bleeding and internal bleeding, were common following PCI [28]. Epistaxis was identified as the main minor bleeding event associated with prasugrel use [29].
Drugs that affect blood coagulation, fibrinolysis, and hemostasis
2014, Side Effects of Drugs AnnualIn-hospital switching of oral P2Y12 inhibitor treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention: Prevalence, predictors and short-term outcome
2014, American Heart JournalCitation Excerpt :Propensity score adjustment was used, nevertheless we cannot rule-out residual bias due to either unmeasured confounding or over-adjustment. Finally, the included in outcome analysis bleeding BARC type 1 may not be clinically meaningful by itself, however it has been shown to affect antiplatelet discontinuation rates.20,21 Having 3 oral P2Y12 inhibitors to select for clinical use in addition to aspirin in patients with ACS undergoing PCI, in-hospital switching represents a common clinical practice.
This work was supported by an institutional grant from Assistance Publique – Hôpitaux de Marseille, Marseille, France.
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Drs. Armero and Bonello contributed equally to this study.