Major bleeding in patients with peripheral artery disease: Insights from the EUCLID trial.

Ward, Rachael; Huang, Zhen; Rockhold, Frank W; Baumgartner, Iris; Berger, Jeffrey S; Blomster, Juuso I; Fowkes, F Gerry R; Katona, Brian G; Mahaffey, Kenneth W; Norgren, Lars; Vemulapalli, Sreekanth; Povsic, Thomas J; Mehta, Rajendra; Hiatt, William R; Patel, Manesh R; Jones, W Schuyler (2020). Major bleeding in patients with peripheral artery disease: Insights from the EUCLID trial. American Heart Journal, 220, pp. 51-58. Elsevier 10.1016/j.ahj.2019.11.007

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BACKGROUND Rates and predictors of major bleeding in patients with peripheral artery disease (PAD) treated with antiplatelets have not been well studied. This post hoc analysis of EUCLID aimed to determine the incidence of major/minor bleeding, predictors of major bleeding, and risk of major adverse cardiovascular events (MACE) following major bleeding events. METHODS EUCLID, a multicenter randomized controlled trial of 13,885 patients with symptomatic PAD, compared ticagrelor with clopidogrel for the prevention of MACE. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. Baseline characteristics were used to develop a multivariable model to determine factors associated with TIMI major bleeding. The occurrence and timing of MACE relative to a first major bleeding event were determined. RESULTS TIMI major bleeding occurred in 2.3% of participants overall (0.94 event/100 patient-years). There was no significant difference in major bleeding rates by treatment assignment. Factors associated with TIMI major bleeding included older age, geographic region, Rutherford class, and β-blocker use. Patients with TIMI major bleeding postrandomization had an increased risk of MACE (hazard ratio [HR] 4.46; 95% CI 3.40-5.84; P < .0001) compared with those without major bleeding; the association was strongest within 30 days after a bleeding event. CONCLUSIONS In patients with symptomatic PAD, 0.94 major bleeding event/100 patient-years was observed and associated with older age, residing in North America, disease severity, and β-blocker use. Patients who had a major bleeding event were significantly more likely to experience MACE, especially within the first 30 days, when compared with patients who did not have major bleeding.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Baumgartner, Iris

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0002-8703

Publisher:

Elsevier

Language:

English

Submitter:

Catherine Gut

Date Deposited:

24 Jan 2020 17:14

Last Modified:

24 Jan 2020 17:23

Publisher DOI:

10.1016/j.ahj.2019.11.007

PubMed ID:

31783279

BORIS DOI:

10.7892/boris.137600

URI:

https://boris.unibe.ch/id/eprint/137600

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