Abstract 4456: The Impact of Nuisance Bleeding on Clopidogrel Compliance in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents
Premature cessation of clopidogrel is a strong risk factor for stent thrombosis. The impact that superficial or nuisance bleeding may have on clopidogrel compliance is not well described. The study population consisted of 2360 unselected patients undergoing successful drug-eluting stent implantation. Self reported nuisance bleeding defined as easy bruising, bleeding from small cuts, petechia and ecchymosis, was assessed during routine clinical follow-up. Internal and alarming (blood transfusion, intracranial, life threatening) bleeding was recorded. Cessation of clopidogrel within 12 months of PCI as a consequence of such bleeding was then assessed. Study population characteristics: 66.1% male; age 64.5±11.8 yrs; diabetes 31.1%; smoking 18.5%; hypertension 81.8%; dyslipidemia 87.9%; history of coronary artery disease 49.1%; chronic renal insufficiency 8.7%; and acute myocardial infarction 10.8%. 837 patients reported bleeding events (incidence=32.4%) of which 88.5% were nuisance, 14.7% were internal, and 0.8% were alarming. Rates of antiplatelet discontinuation are presented. 12.1% and 18.1% of patients with bleeding stopped aspirin and clopidogrel, respectively. Nuisance bleeding is common in patients taking dual antiplatelet therapy post-PCI. 11.1% of patients with nuisance bleeding discontinued clopidogrel therapy. Greater education and follow-up is required in this patient subset.