Rate of nuisance bleedings and impact on compliance to prasugrel in acute coronary syndromes

Am J Cardiol. 2011 Dec 15;108(12):1710-3. doi: 10.1016/j.amjcard.2011.07.038. Epub 2011 Sep 8.


Antiplatelet agents are critical to prevent thrombotic events in patients with acute coronary syndromes, particularly those who undergo percutaneous coronary intervention. Prasugrel is a potent P2Y(12)-adenosine diphosphate receptor antagonist that is superior to clopidogrel in such patients. Previous studies have observed that nuisance and internal bleedings were relatively frequent in patients under clopidogrel therapy and were associated with noncompliance. Furthermore, premature drug discontinuation is associated with thrombotic recurrences. The aim of the present study was to investigate the rate of nuisance or internal bleedings in patients receiving prasugrel and its relation with compliance. This prospective multicenter study included 396 patients. Bleeding events were recorded and classified as alarming, nuisance, or internal according. Compliance with prasugrel therapy was assessed. Almost half of the patients (48.5%) were included for ST-segment elevation acute coronary syndromes. During the 1-month follow-up period, 54 patients (13.6%) had bleeding events. Most bleeding events were classified as internal or nuisance (96%). Internal and nuisance bleedings were associated with high rates of prasugrel discontinuation (16.6% and 14.7%, respectively). Nuisance and internal bleedings were significantly associated with prasugrel discontinuation in multivariate analysis (odds ratio 3.1, 95% confidence interval 1.01 to 9.2, p = 0.04). The rate of major adverse cardiovascular events was 2.3%. No relation was observed between minor bleeds, compliance, and major adverse cardiovascular events. In conclusion, in the present study, minor bleedings were common during the first month after percutaneous coronary intervention and were significantly associated with prasugrel withdrawal.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Female
  • Gastrointestinal Hemorrhage / chemically induced*
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Piperazines / adverse effects*
  • Platelet Aggregation Inhibitors / adverse effects*
  • Prasugrel Hydrochloride
  • Prospective Studies
  • Thiophenes / adverse effects*


  • Piperazines
  • Platelet Aggregation Inhibitors
  • Thiophenes
  • Prasugrel Hydrochloride