Nuisance bleeding tied to early increase in bleeding risk in patients with acute MI on DAPT: Circulation

The authors reported the following findings:

· Nuisance bleeding occurred in 16.7% of patients following one month of ticagrelor-based DAPT.

· NB was not associated with a rise in BARC 2, 3, or 5 bleeding (hazard ratio [HR]‚ 1.29) and major adverse cardiovascular events (HR‚ 1.72) at one year.

·At six months, NB patients had an increased BARC 2, 3, or 5 bleeding risk(HR, 1.94), which diminished over the next six months.

· De-escalation from ticagrelor to clopidogrel decreased the incidence of BARC 2, 3, or 5 bleeding versus ticagrelor plus aspirin in NB (HR‚ 0.31) and non-NB patients (HR‚ 0.58) without heterogeneity.

· There was no increase in the major adverse cardiovascular event after DAPT de-escalation, regardless of NB.

The researchers wrote, "patients with AMI who experience NB in the first month after first-month post-PCI after going on ticagrelor-based DAPT are more apt to have more severe bleeding events later."

"DAPT de-escalation by switching to clopidogrel at the 1-month mark appears to reduce the risk of subsequent bleeding without increasing ischemic events for patients with NB and those without."

Reference:

The study titled "Prognosis and the Effect of De-Escalation of Antiplatelet Therapy After Nuisance Bleeding in Patients With Myocardial Infarction" was published in Circulation: Cardiovascular Interventions.

DOI: https://doi.org/10.1161/CIRCINTERVENTIONS.122.012157