Incidence and Risk Factors for Antiplatelet Therapy-Related Bleeding Complications Among Elderly Patients After Coronary Stenting: A Multicenter Retrospective Observation

Yanxia Qian; Bing Xu; Xiaodong Qian; Lu Cao; Yujia Cheng; Xinjian Liu; Song Bai; Zhijun Han; Junhong Wang

doi:10.3389/fphar.2021.661619

Incidence and Risk Factors for Antiplatelet Therapy-Related Bleeding Complications Among Elderly Patients After Coronary Stenting: A Multicenter Retrospective Observation

Front Pharmacol. 2021 Jul 30:12:661619. doi: 10.3389/fphar.2021.661619. eCollection 2021.

Authors

Yanxia Qian¹, Bing Xu², Xiaodong Qian³, Lu Cao¹, Yujia Cheng¹, Xinjian Liu^{4

5}, Song Bai⁶, Zhijun Han⁷, Junhong Wang^{1

6}

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Nanjing, China.
² Department of Cardiology, Northern Jiangsu Province Hospital and Clinical Medical College, Yangzhou University, Yangzhou, China.
³ Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
⁴ Department of Pathogenic Microorganism, Nanjing Medical University, Nanjing, China.
⁵ Key Laboratory of Antibody Technique of National Health Commission of China, Department of Pathogen Biology, Nanjing Medical University, Nanjing, China.
⁶ Department of Cardiology, Xuyi People's Hospital, Huai'an, China.
⁷ Department of Laboratory Medicine, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.

Abstract

Purpose: To determine the incidence and risk factors of bleeding events as well as assess the performance of the PRECISE-DAPT score in elderly patients (≥75 years) who underwent percutaneous coronary intervention (PCI) and one-year dual antiplatelet therapy (DAPT). Methods: A total of 940 patients (≥75 years) who received PCI and one-year DAPT were retrospectively enrolled into the study. The multivariable logistic regression analysis was conducted to identify risk factors of antiplatelet-related bleeding complications. The receiver operating characteristic (ROC) curve analysis and the Delong test were performed to obtain the optimized PRECISE-DAPT score. Results: It was observed that 89 (9.47%) patients suffered bleeding complications, while 37 (3.94%) of them had the Bleeding Academic Research Consortium (BARC, type ≥2) bleeding events. We stratified the PRECISE-DAPT score in tertiles (T1: ≤23; T2:24 to 32; T3: ≥33) and found that BARC ≥ 2 type bleeding occurred more frequently in T3 than in T1 and T2 (8.25 vs. 1.46% vs. 2.40%, p <0.05). The ROC curve analysis revealed that the PRECISE-DAPT score cutoff for BARC ≥2 type bleeding prediction was 33. In comparison with the current recommended cutoff score of 25 (AUC: 0.608, based on ROC analysis), the Delong test indicated significantly improved ability for predicting BARC ≥ 2 type bleeding events using the proposed cutoff value of 33, AUC of 0.676 (p = 0.03), and Brier Score of 0.04. The multivariable logistic regression analysis demonstrated that the PRECISE-DAPT score ≥ 33 [OR: 3.772; 95% CI (1.229, 11.578); p = 0.02] was associated with BARC ≥ 2 type bleeding event, along with a history of hemorrhagic stroke [OR: 6.806; 95% CI (1.465, 31.613); p = 0.014], peptic ulcer [OR: 3.871; 95% CI (1.378, 10.871); p = 0.01], and/or myocardial infarction [MI, OR: 3.081; 95% CI (1.140, 8.326); p = 0.027]. Conclusion: A higher PRECISE-DAPT score of 33 might be a more reasonable cutoff value for predicting BARC ≥2 type bleeding risk in CAD patients (≥75 years). In addition, the history of hemorrhagic stroke, peptic ulcer, and myocardial infarction were identified as the risk factors of BARC ≥2 type bleeding events.

Keywords: PRECISE-DAPT score; bleeding risk; dual antiplatelet therapy; elderly patients; risk factors.