This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: November 18, 2008, Volume 118, Number 21 All Versions of this Article: 118/21/2139    most recent CIRCULATIONAHA.108.787143v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Wang, T. Y. Articles by Peterson, E. D. Search for Related Content PubMed PubMed Citation Articles by Wang, T. Y. Articles by Peterson, E. D. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID Medline Plus Health Information Blood Thinners Heart Attack Related Collections Platelet function inhibitors Acute myocardial infarction Related Article

(Circulation. 2008;118:2139-2145.)
© 2008 American Heart Association, Inc.

Health Services and Outcomes Research

Antiplatelet Therapy Use After Discharge Among Acute Myocardial Infarction Patients With In-Hospital Bleeding

Tracy Y. Wang, MD, MHS; Lan Xiao, PhD; Karen P. Alexander, MD; Sunil V. Rao, MD; Mikhail N. Kosiborod, MD; John S. Rumsfeld, MD, PhD; John A. Spertus, MD, MPH; Eric D. Peterson, MD, MPH

From the Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (T.Y.W., K.P.A., S.V.R., E.D.P.); Mid America Heart Institute and University of Missouri–Kansas City, Kansas City, Mo (L.X., M.N.K., J.A.S.); and the Denver Veterans Affairs Medical Center, Denver, Colo (J.S.R.).

Correspondence to Tracy Y. Wang, MD, MHS, Duke Clinical Research Institute, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705. E-mail wang0085{at}mc.duke.edu

Received April 18, 2008; accepted September 12, 2008.

Background— Bleeding among patients with acute myocardial infarction (AMI) is associated with worse long-term outcomes. Although the mechanism underlying this association is unclear, a potential explanation is that withholding antiplatelet therapies long beyond resolution of the bleeding event may contribute to recurrent events.

Methods and Results— We examined medication use at discharge, 1, 6, and 12 months after AMI among 2498 patients in the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) registry. Bleeding was defined as non–coronary artery bypass graft–related Thrombolysis of Myocardial Infarction major/minor bleeding or transfusion among patients with baseline hematocrit 28%. Logistic regression was used to evaluate the association between bleeding during the index AMI hospitalization and medication use. In-hospital bleeding occurred in 301 patients (12%) with AMI. Patients with in-hospital bleeding were less likely to be discharged on aspirin or thienopyridine (adjusted odds ratio=0.45; 95% CI, 0.31 to 0.64; and odds ratio=0.62; 95% CI, 0.42 to 0.91, respectively). At 1 month after discharge, although patients with in-hospital bleeding remained significantly less likely to receive aspirin (odds ratio=0.68; 95% CI, 0.50 to 0.92), use of thienopyridines in the 2 groups started to become similar. By 1 year, antiplatelet therapy use was similar among patients with and without bleeding. Postdischarge cardiology follow-up was associated with greater antiplatelet therapy use than either primary care or no clinical follow-up.

Conclusions— Patients whose index AMI is complicated by bleeding are less likely to be treated with antiplatelet therapies during the first 6 months after discharge. Early reassessment of antiplatelet eligibility may represent an opportunity to reduce the long-term risk of adverse outcomes associated with bleeding.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 2115-2116. [Extract] [Full Text]