TY - JOUR
T1 - Impact of "Nuisance" Bleeding on Clopidogrel Compliance in Patients Undergoing Intracoronary Drug-Eluting Stent Implantation
AU - Roy, Probal
AU - Bonello, Laurent
AU - Torguson, Rebecca
AU - de Labriolle, Axel
AU - Lemesle, Gilles
AU - Slottow, T. L P
AU - Steinberg, Daniel H.
AU - Kaneshige, Kimberly
AU - Xue, Zhenyi
AU - Satler, Lowell F.
AU - Kent, Kenneth M.
AU - Suddath, William O.
AU - Pichard, Augusto D.
AU - Lindsay, Joseph
AU - Waksman, Ron
PY - 2008/12/15
Y1 - 2008/12/15
N2 - Premature cessation of clopidogrel is a strong risk factor for drug-eluting stent thrombosis in patients undergoing percutaneous coronary intervention. The impact that superficial or "nuisance" bleeding may have on clopidogrel compliance has not been described. The study population consisted of 2,360 unselected patients undergoing successful drug-eluting stent implantation. Nuisance bleeding, defined as easy bruising, bleeding from small cuts, petechia, and ecchymosis, was assessed during routine clinical follow-up. Internal and alarming bleeding was recorded. Cessation of clopidogrel as a consequence of such bleeding was then assessed. Study population characteristics were 66.1% men, mean age 64.5 ± 11.8 years, diabetes mellitus in 31.1%, smoking in 18.5%, systemic hypertension in 81.8%, dyslipidemia in 87.9%, history of coronary artery disease in 49.1%, chronic renal insufficiency in 8.7%, and acute myocardial infarction in 10.8%. A total of 837 patients reported bleeding events (incidence 32.4%) of which 85.7% were nuisance, 13.6% were internal, and 0.7% were alarming. Rate of clopidogrel discontinuation as a result of bleeding in the nuisance bleeding group was 11.1%. In conclusion, superficial or nuisance bleeding is common in patients taking dual antiplatelet therapy after percutaneous coronary intervention. Overall, 11.1% of patients with nuisance bleeding discontinued clopidogrel. Greater education and follow-up in this patient subset may lead to improved compliance with clopidogrel therapy.
AB - Premature cessation of clopidogrel is a strong risk factor for drug-eluting stent thrombosis in patients undergoing percutaneous coronary intervention. The impact that superficial or "nuisance" bleeding may have on clopidogrel compliance has not been described. The study population consisted of 2,360 unselected patients undergoing successful drug-eluting stent implantation. Nuisance bleeding, defined as easy bruising, bleeding from small cuts, petechia, and ecchymosis, was assessed during routine clinical follow-up. Internal and alarming bleeding was recorded. Cessation of clopidogrel as a consequence of such bleeding was then assessed. Study population characteristics were 66.1% men, mean age 64.5 ± 11.8 years, diabetes mellitus in 31.1%, smoking in 18.5%, systemic hypertension in 81.8%, dyslipidemia in 87.9%, history of coronary artery disease in 49.1%, chronic renal insufficiency in 8.7%, and acute myocardial infarction in 10.8%. A total of 837 patients reported bleeding events (incidence 32.4%) of which 85.7% were nuisance, 13.6% were internal, and 0.7% were alarming. Rate of clopidogrel discontinuation as a result of bleeding in the nuisance bleeding group was 11.1%. In conclusion, superficial or nuisance bleeding is common in patients taking dual antiplatelet therapy after percutaneous coronary intervention. Overall, 11.1% of patients with nuisance bleeding discontinued clopidogrel. Greater education and follow-up in this patient subset may lead to improved compliance with clopidogrel therapy.
UR - http://www.scopus.com/inward/record.url?scp=57649084454&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2008.07.063
DO - 10.1016/j.amjcard.2008.07.063
M3 - Article
C2 - 19064014
AN - SCOPUS:57649084454
SN - 0002-9149
VL - 102
SP - 1614
EP - 1617
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 12
ER -