Clinical factors predict post-MI gastrointestinal bleeding risk
MedWire News: Researchers have identified clinical characteristics that predict risk for gastrointestinal (GI) bleeding following a myocardial infarction (MI), data they say could help clinicians to be particularly vigilant when managing patients with multiple such risk factors.
Use of dual antiplatelet therapy, increasingly common in acute coronary syndrome management, was a powerful predictor of GI bleeding, while a number of demographic and historic factors also predicted risk, including age, non-White race, and a history of alcohol abuse.
GI bleeding has previously been found to be independently associated with increased length of hospitalization and mortality in MI patients undergoing primary percutaneous coronary intervention (PCI), but risk factors for GI bleeding have not been well defined, explain Scott Solomon (Brigham and Women’s Hospital, Boston, Massachusetts, USA) and team in the European Heart Journal.
In their secondary analysis of adverse events among 14,703 patients with heart failure, systolic dysfunction, or both, after MI in the VALIANT (Valsartan in Acute MI) trial, the researchers found that 98 (0.7%) patients had a serious GI bleeding event during the 3-year follow-up period.
These patients were older, had more comorbidities, were more likely to be taking additional antiplatelet drugs, and had worse systolic and renal function than patients without serious GI bleeding.
Multivariable stepwise regression analysis showed that dual antiplatelet therapy (prescribed to 23% of patients in the first month, declining to 5% after the third month) was associated with a more than three-fold increased risk for GI bleeding, at a hazard ratio [HR] of 3.18 (p<0.001).
Other potent risk factors were history of alcohol abuse (HR=4.71), non-White race (HR=3.26), and age (HR=1.51 per 10-year increment; all significant at p<0.001).
New York Heart Association functional class III or IV (HR=2.27, p=0.001), anticoagulant therapy (HR=2.13, p=0.003), diabetes (HR=1.76, p=0.013), and reduced glomerular filtration rate (HR=1.18 per 10 ml/min/1.73 m2 decrement), as well as being male (HR=1.82, p=0.021) were also associated with increased GI bleeding risk.
GI bleeding portended an increased risk for death (HR=2.54), but the majority of deaths were not caused by the bleeding event, and “it is likely that the cohort experiencing GI bleeding events represented a group of patients with additional comorbidities not accounted for by our multivariable model,” the authors comment.
“This analysis can be useful in identifying patients with increased GI bleeding risk potentially leading to increased vigilance with regard to GI outcomes,” they conclude.
The team notes: “Whether therapy aimed at attenuating that risk would be of benefit or cost-effective in this population remains unknown.”
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By Caroline Price