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Sökning: (WFRF:(Neely G. G.)) pers:(Liaw Danny) > Characterising and ...

  • Khan, RaziUniv Montreal, Montreal Heart Inst, Montreal, PQ, Canada. (författare)

Characterising and predicting bleeding in high-risk patients with an acute coronary syndrome

  • Artikel/kapitelEngelska2015

Förlag, utgivningsår, omfång ...

  • 2015-06-24
  • BMJ,2015
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-262962
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-262962URI
  • https://doi.org/10.1136/heartjnl-2014-307346DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Objective In the Apixaban for Prevention of Acute Ischemic Events (APPRAISE-2) trial, the use of apixaban, when compared with placebo, in high-risk patients with a recent acute coronary syndrome (ACS) resulted in a significant increase in bleeding without a reduction in ischaemic events. The aim of this analysis was to provide further description of these bleeding events and to determine the baseline characteristics associated with bleeding in high-risk post-ACS patients. Methods APPRAISE-2 was a multinational clinical trial including 7392 high-risk patients with a recent ACS randomised to apixaban (5 mg twice daily) or placebo. Bleeding including Thrombolysis in Myocardial Infarction (TIMI) major or minor bleeding, International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, and any bleeding were analysed using an on-treatment analysis. Kaplan-Meier curves were plotted to describe the timing of bleeding, and a Cox proportional hazards model was used to identify predictors of ISTH major or CRNM bleeding and any bleeding. Median follow-up was 241 days. Results The proportion of patients who experienced TIMI major or minor, ISTH major or CRNM, and any bleeding was 1.5%, 2.2% and 13.3%, respectively. The incidence of bleeding was highest in the immediate post-ACS period (0.11 in the first 30 days vs 0.03 after 30 days events per 1 patient-year); however, > 60% of major bleeding events occurred > 30 days after the end of the index hospitalisation. Gastrointestinal bleeding was the most common cause of major bleeding, accounting for 45.9% of TIMI major or minor and 39.5% of ISTH major or CRNM bleeding events. Independent predictors of ISTH major or CRNM bleeding events included older age, renal dysfunction, dual oral antiplatelet therapy, smoking history, increased white cell count and coronary revascularisation. Conclusions When compared with placebo, the use of apixaban is associated with an important short-term and long-term risk of bleeding in high-risk post-ACS patients, with gastrointestinal bleeding being the most common source of major bleeding. The baseline predictors of major bleeding appear to be consistent with those identified in lower-risk ACS populations with shorter-term follow-up.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Lopes, Renato D.Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. (författare)
  • Neely, Megan L.Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. (författare)
  • Stevens, Susanna R.Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. (författare)
  • Harrington, Robert A.Stanford Sch Med, Stanford, CA USA. (författare)
  • Diaz, RafaelECLA Estudios Cardiol Latinoamer, Rosario, Santa Fe, Argentina. (författare)
  • Cools, FrankAcad Ziekenhuis Klina, Brasschaat, Belgium. (författare)
  • Jansky, PetrUniv Hosp Motol, Prague, Czech Republic. (författare)
  • Montalescot, GillesPitie Salpetriere Univ Hosp, Inst Cardiol, Paris, France. (författare)
  • Atar, DanUniv Oslo, Oslo Univ Hosp, Oslo, Norway.;Univ Oslo, Inst Clin Sci, Oslo, Norway. (författare)
  • Lopez-Sendon, JoseUniv Hosp La Paz, Madrid, Spain. (författare)
  • Flather, MarcusRoyal Brompton Hosp & Harefield NHS Fdn Trust, Clin Trials & Evaluat Unit, London, England. (författare)
  • Liaw, DannyBristol Myers Squibb Co, Princeton, NJ USA. (författare)
  • Wallentin, LarsUppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi(Swepub:uu)larswall (författare)
  • Alexander, John H.Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. (författare)
  • Goodman, Shaun G.Univ Toronto, St Michaels Hosp, Terrence Donnelly Heart Ctr, Toronto, ON, Canada.;Canadian Heart Res Ctr, Toronto, ON, Canada. (författare)
  • Univ Montreal, Montreal Heart Inst, Montreal, PQ, Canada.Duke Univ, Duke Clin Res Inst, Durham, NC 27705 USA. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Heart: BMJ101:18, s. 1475-14841355-60371468-201X

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  • Heart (Sök värdpublikationen i LIBRIS)

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