Bleeding Risk Following Percutaneous Intervention in Patients with Diabetes Prescribed Dual Anti Platelet Therapy
Abstract
Patients with diabetes (DM) experience higher rates of in-stent restenosis and
therefore greater benefit from drug eluting stent (DES) implant at the time of percutaneous
coronary intervention (PCI). DES stent implantation necessitates prolonged dual anti-platelet
therapy (DAPT). While DAPT reduces the risk of ischemic events post-PCI, it also increases
the risk for bleeding. Whether long-term rates of bleeding differ among patients with and
without DM receiving DAPT in real-world practice is unknown.
Among patients who underwent PCI and were maintained on DAPT for 1 year in a
multicenter US PCI registry, OPS/PRISM, we assessed patient-reported bleeding (defined
according to the Bleeding Academic Research Consortium, BARC) over the year following
PCI in patients with and without DM. Bleeding assessments were conducted by a study
coordinator at index hospitalization (baseline) and at 1, 6 and 12 months following discharge.
Multivariable logistic regression was used to evaluate the association of DM with bleeding
during follow-up. In a sensitivity analysis, we excluded bruising from BARC-defined
bleeding events. Covariates included in the model were selected a priori and were abstracted
from the medical record by study coordinators. Covariates included demographic (e.g. age,
insurance status) and clinical (e.g. medical history, procedural indication) variables.
Among 2270 PCI patients (mean age 64, 72% male, 54% ACS), 32.6% had DM. In
unadjusted analyses, patients with DM had fewer BARC ≥1 bleeding events over the year
following PCI (DM vs no DM: BARC ≥1: 77.7% vs 87.6%, p<0.001; BARC ≥ 2: 4.5% vs
5.3%, p=0.41). After adjusting for demographic and clinical factors, patients with DM had
lower odds of BARC ≥1 bleeding during follow-up (odds ratio [OR] 0.52, 95% CI 0.39-0.68,
p<0.001 vs. no DM). This decreased odds of bleeding persisted after removing bruising from
the endpoint definition (OR 0.77, 95% CI 0.62-0.96).
In a real-world PCI registry, patients with DM experienced lower bleeding on DAPT
than those without DM. As patients with DM also derive greater ischemic benefit from DES,
which requires prolonged DAPT, our findings suggest that the balance between benefit and
risk of this therapeutic approach is even more favorable in patients with DM than previously
considered.
Table of Contents
Introduction -- Methodology -- Results -- Discussion -- Appendix
Degree
M.S.