Impact of Anemia on the Risk of Bleeding Following Percutaneous Coronary Interventions in Patients ≥75 Years of Age

Am J Cardiol. 2020 Apr 15;125(8):1142-1147. doi: 10.1016/j.amjcard.2020.01.010. Epub 2020 Feb 19.

Abstract

Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / surgery*
  • Aged
  • Aged, 80 and over
  • Anemia / epidemiology*
  • Angina, Unstable / epidemiology
  • Angina, Unstable / surgery
  • Anticoagulants / therapeutic use
  • Antithrombins / therapeutic use
  • Aspirin / therapeutic use
  • Cause of Death
  • Clopidogrel / therapeutic use
  • Comorbidity
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / surgery*
  • Drug-Eluting Stents
  • Female
  • Gastrointestinal Hemorrhage / chemically induced
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / mortality
  • Hemorrhage / chemically induced
  • Hemorrhage / epidemiology
  • Hemorrhage / mortality
  • Heparin / therapeutic use
  • Hirudins
  • Humans
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Hemorrhages / epidemiology
  • Intracranial Hemorrhages / mortality
  • Kaplan-Meier Estimate
  • Male
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / surgery
  • Peptide Fragments / therapeutic use
  • Percutaneous Coronary Intervention / methods*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Postoperative Care
  • Postoperative Hemorrhage / chemically induced
  • Postoperative Hemorrhage / epidemiology*
  • Postoperative Hemorrhage / mortality
  • Prasugrel Hydrochloride / therapeutic use
  • Proportional Hazards Models
  • Prospective Studies
  • Recombinant Proteins / therapeutic use
  • Risk Assessment
  • Stents
  • Ticagrelor / therapeutic use
  • Urologic Diseases / chemically induced
  • Urologic Diseases / epidemiology
  • Urologic Diseases / mortality

Substances

  • Anticoagulants
  • Antithrombins
  • Hirudins
  • Peptide Fragments
  • Platelet Aggregation Inhibitors
  • Recombinant Proteins
  • Heparin
  • Clopidogrel
  • Prasugrel Hydrochloride
  • Ticagrelor
  • Aspirin
  • bivalirudin