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Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants

Yoshida, Ruka MD*,†; Ishii, Hideki MD, PhD; Morishima, Itsuro MD, PhD; Tanaka, Akihito MD, PhD*; Morita, Yasuhiro MD, PhD; Takagi, Kensuke MD; Yoshioka, Naoki MD; Hirayama, Kenshi MD; Iwakawa, Naoki MD; Tashiro, Hiroshi MD*; Kojima, Hiroki MD*; Mitsuda, Takayuki MD*; Hitora, Yusuke MD; Furusawa, Kenji MD*; Tsuboi, Hideyuki MD, PhD; Murohara, Toyoaki MD, PhD

Journal of Cardiovascular Pharmacology: September 2019 - Volume 74 - Issue 3 - p 210–217
doi: 10.1097/FJC.0000000000000702
Original Article
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Abstract: Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score–matched pairs (hazard ratio 6.21, 95% confidence interval 3.29–11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68–14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.

*Department of Cardiology, Nagoya University Hospital, Nagoya, Japan;

Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan; and

Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Reprints: Ruka Yoshida, MD, Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan (e-mail: lyoshida@hotmail.com).

Supported by a grant from Aichi Kidney Foundation and Grant-in-Aid for Scientific Research (KAKENHI) (No. 1 7 K 0 9 4 9 3) of the Ministry of Education, Culture, Sports, Science and Technology (MEXT) and Japanese Society for the Promotion of Science (JSPA).

H. Ishii received lecture fees from Astellas Pharma Inc, Bayer Pharmaceutical Co, Ltd, Daiichi-Sankyo Pharma Inc, and MSD K. K. T. Murohara received lecture fees from Bayer Yakuhin., Ltd., Daiichi-Sankyo Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd. Department of Cardiology, Nagoya University Graduate School of Medicine received research grant from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd. The remaining authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcvp.org).

Received February 08, 2019

Accepted May 09, 2019

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