Abstract 10977: A Novel Self-Report Measure of Nuisance Bleeding Following Chronic Antiplatelet Drug Therapy

Abstract

Introduction: Antiplatelet drug therapy (AT) prevents cardiovascular events in patients with stroke, acute coronary syndromes, peripheral arterial disease, and percutaneous coronary interventions including drug eluting stent. Major, minor, and nuisance bleeding episodes may occur with AT. Multiple tools and scoring systems have been developed to measure major and minor bleeding episodes. However, there is a paucity of tools to specifically measure nuisance bleeding. Nuisance bleeding may contribute to lower adherence to AT, however research is limited because of the lack of instrumentation for nuisance bleeding. Objective: To evaluate the psychometric properties of a newly developed instrument to measure nuisance bleeding (Nuisance Bleeding Scale; NBS).

Method: Community dwelling cardiovascular patients with a self-reported prescription for clopidogrel were recruited via print advertising and subsequently completed the NBS. The NBS is a checklist to measure the occurrence and perceived severity of nuisance bleeding. Items for the NBS were generated through a literature review and reviewed by content experts. Respondents reported the occurrence of 9 different types of nuisance bleeding such as: easy bruising, bruising of extremities, and bleeding gums. For each type of nuisance bleeding, respondents rated the severity on a 5 point Likert scale.

Results: The sample (N=103) were primarily white (91.3%), males (58.3%), with a mean age of 72.3 (SD 10.1) years. Ninety three percent reported having nuisance bleeding. Overall, the mean extent of nuisance bleeding was 3.52 (SD 4.4; possible range 1 to 9). The mean severity of nuisance bleeding was 5.27 (SD 6.2; possible range 0 to 45). Internal consistency reliability for the checklist for types of nuisance bleeding was .69 and for the severity items was .90. Item level statistics suggested the item “nose bleed” was weak, with low variability.

Conclusions: The NBS demonstrated preliminary evidence of adequate internal consistency reliability and content validity. Further psychometric testing is warranted particularly the relationship between nuisance bleeding and objective measures of AT adherence.