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  • Alfredsson, JoakimLinköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US,Duke Clin Research Institute, NC USA (author)

Predicting the risk of bleeding during dual antiplatelet therapy after acute coronary syndromes

  • Article/chapterEnglish2017

Publisher, publication year, extent ...

  • 2017-04-05
  • BMJ PUBLISHING GROUP,2017
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:liu-139535
  • https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-139535URI
  • https://doi.org/10.1136/heartjnl-2016-310090DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • Funding Agencies|Daiichi Sankyo; Eli Lilly and Company; Merck Co.
  • Objectives Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there are no decision support tools available to predict an individual patients bleeding risk during DAPT treatment in the post-ACS setting. Methods To develop a longitudinal bleeding risk prediction model, we analysed 9240 patients with unstable angina/non-ST segment elevation myocardial infarction (NSTEMI) from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial, who were managed without revascularisation and treated with DAPT for a median of 14.8 months. Results We identified 10 significant baseline predictors of non-coronary artery bypass grafting (CABG)-related Global Use of Strategies to Open Occluded Arteries (GUSTO) severe/life-threatening/moderate bleeding: age, sex, weight, NSTEMI (vs unstable angina), angiography performed before randomisation, prior peptic ulcer disease, creatinine, systolic blood pressure, haemoglobin and treatment with beta-blocker. The five significant baseline predictors of Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding included age, sex, angiography performed before randomisation, creatinine and haemoglobin. The models showed good predictive accuracy with Therneaus C-indices: 0.78 (SE=0.024) for the GUSTO model and 0.67 (SE=0.023) for the TIMI model. Internal validation with bootstrapping gave similar C-indices of 0.77 and 0.65, respectively. External validation demonstrated an attenuated C-index for the GUSTO model (0.69) but not the TIMI model (0.68). Conclusions Longitudinal bleeding risks during treatment with DAPT in patients with ACS can be reliably predicted using selected baseline characteristics. The TRILOGY ACS bleeding models can inform riskbenefit considerations regarding the duration of DAPT following ACS.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Neely, BenjaminDuke Clin Research Institute, NC USA (author)
  • Neely, Megan L.Duke Clin Research Institute, NC USA (author)
  • Bhatt, Deepak L.Brigham and Womens Hospital, MA 02115 USA; Harvard Medical Sch, MA USA (author)
  • Goodman, Shaun G.St Michaels Hospital, Canada; University of Alberta, Canada; University of Alberta, Canada (author)
  • Tricoci, PierluigiDuke Clin Research Institute, NC USA; Duke University, NC 27706 USA (author)
  • Mahaffey, Kenneth W.Stanford University, CA 94305 USA (author)
  • Cornel, Jan H.Medical Centre Alkmaar, Netherlands (author)
  • White, Harvey D.Auckland City Hospital, New Zealand (author)
  • Fox, Keith A. A.University of Edinburgh, Scotland (author)
  • Prabhakaran, DorairajCentre Chron Disease Control and Public Health Fdn India, India (author)
  • Winters, Kenneth J.Eli Lilly and Co, IN 46285 USA (author)
  • Armstrong, Paul W.University of Alberta, Canada; University of Alberta, Canada (author)
  • Magnus Ohman, E.Duke Clin Research Institute, NC USA; Duke University, NC 27706 USA (author)
  • Roe, Matthew T.Duke Clin Research Institute, NC USA; Duke University, NC 27706 USA (author)
  • Linköpings universitetAvdelningen för kardiovaskulär medicin (creator_code:org_t)

Related titles

  • In:Heart: BMJ PUBLISHING GROUP103:15, s. 1168-11761355-60371468-201X

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