Prolonged Dual Antiplatelet Therapy Is Associated with Nuisance Bleeding

Kirsten E. Fleischmann, MD, MPH

After myocardial infarction, even nondangerous bleeding affected quality of life adversely.

Dual antiplatelet therapy (e.g., clopidogrel plus aspirin) is prescribed commonly to patients after myocardial infarction (MI) and percutaneous coronary intervention (PCI), but it is associated with elevated bleeding risk. In this multicenter cohort analysis, U.S. investigators assessed the effect of dual antiplatelet therapy–related nuisance bleeding (i.e., bleeding, bruising, and gum or nose bleeds that did not require hospitalization, transfusion, or change in medication) on quality of life (QOL) in 3560 post-MI patients, most of whom also underwent PCI.

During 12 months after MI, 1335 patients (37.5%) reported nuisance bleeding. After adjustment for baseline risks, ongoing dual antiplatelet therapy, compared with no dual antiplatelet therapy (the authors did not specify how many patients were receiving monotherapy or no therapy), was the strongest predictor of nuisance bleeding (rate ratios, 1.4 at 1 month; 1.9 at 6 months; 1.4 at 12 months). Other variables associated with nuisance bleeding were female sex (RR, 1.3) and history of atrial fibrillation (RR, 1.4). Nuisance bleeding was associated with significantly lower QOL and higher levels of pain or discomfort and anxiety or depression.

Citation(s):

Amin AP et al. Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status. J Am Coll Cardiol 2013 May 28; 61:2130.