Bleeding and ischemic events during dual antiplatelet therapy after second-generation drug-eluting stent implantation in hemodialysis patients
| Autor: | Konosuke Inoue, Yutaka Otsuji, Masaru Araki, Yuki Tsuda, Akiyoshi Shimizu, Koshi Setoyama, Yasushi Oginosawa, Yoshitaka Muraoka, Tetsu Miyamoto, Shinjo Sonoda, Yoshinori Sanuki, Reo Anai, Toshiya Miura |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Hemorrhage 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Postoperative Complications Ischemia Renal Dialysis Risk Factors Internal medicine Clinical endpoint medicine Humans 030212 general & internal medicine Aged Retrospective Studies business.industry Dual Anti-Platelet Therapy Hazard ratio Percutaneous coronary intervention Stent Drug-Eluting Stents Thrombosis Middle Aged medicine.disease Drug-eluting stent Conventional PCI Cardiology Female Hemodialysis Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Kidney disease |
| Zdroj: | Journal of cardiology. 73(6) |
| ISSN: | 1876-4738 |
| Popis: | Dual-antiplatelet therapy (DAPT) after second-generation drug-eluting stent (2nd-DES) implantation reduces the risk of stent thrombosis and subsequent ischemic events, with an increase in bleeding risk. Although chronic kidney disease patients have both high ischemic and bleeding events, little is known about both risks during DAPT in hemodialysis (HD) patients.From July 2009 to March 2017, we retrospectively analyzed bleeding events and major adverse cardiac and cerebrovascular events (MACCE) in 644 consecutive patients who underwent successful percutaneous coronary intervention (PCI) with 2nd-DES implantation in our institution. We divided the patients into 2 groups [102 HD and 518 non-HD patients] after excluding 24 patients. The primary endpoint was bleeding events of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5. The secondary endpoint was MACCE. We also investigated potential bleeding risk factors in those patients.At a median follow-up of 49 months, bleeding events occurred in 76 (12.3%) patients. Critical bleeding events of BARC type 3 or 5 occurred more frequently in HD (HD vs. non-HD: 16.7% vs. 7.1%; p=0.004). Most events tended to occur within 6 months post PCI. Multivariate analysis demonstrated that HD [hazard ratio (HR) 2.50, 95% confidence interval (CI) 1.03-3.16; p=0.04], body mass index (BMI) (HR 0.91, 95%CI 0.87-0.99, p=0.02), and serum albumin (HR 0.35, 95%CI 0.34-0.96, p=0.03) were independent predictors of bleeding events. MACCE also occurred more frequently in HD (HD vs. non-HD: 53.9% vs. 29.3%; p0.001). Multivariate analysis demonstrated that pre-dialysis systolic blood pressure (HR 1.03, 95%CI 1.00-1.06, p=0.02) and high-sensitive C-reactive protein level (HR 1.76, 95%CI 1.06-2.72, p=0.03) were independent predictors of bleeding events in HD.HD displayed more adverse bleeding and ischemic events compared with non-HD. Therefore, practitioners should reconsider the current regimen of DAPT in this patient cohort to prevent critical bleeding complications and spates of ischemic events. |
| Databáze: | OpenAIRE |
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