Bleeding during DAPT more likely in patients on haemodialysis
Dual-antiplatelet therapy (DAPT) may increase the risk of bleeding and ischaemic events in patients with second-generation drug-eluting stent (2nd-DES) implants undergoing haemodialysis (HD), a recent study suggests.
Researchers retrospectively analysed 620 patients who underwent percutaneous coronary intervention with 2nd-DES implantation. Most patients (n=518; mean age, 71.4±10.5 years; 71.4 percent male) were not undergoing HD, while the remaining 102 (mean age 68.4±10.4 years; 64.7 percent male) were. The Bleeding Academic Research Consortium (BARC) criteria was used to evaluate the primary outcome of bleeding events during DAPT.
A total of 76 patients (12.3 percent) experienced bleeding events. Specifically, BARC type 2, 3 and 5 events were reported in 21 (3.4 percent), 46 (7.4 percent) and nine (1.5 percent) participants, respectively. The likelihood of such bleeding events occurring was significantly higher in those undergoing HD (hazard ratio [HR], 2.50; 95 percent CI, 1.49–4.06; p<0.001).
The same was true for BARC type 3 or 5 (HR, 2.83; 1.55–4.95). On the other hand, major bleeding events, such as intracranial and gastrointestinal bleeding, were comparable between HD and non-HD patients.
Multivariate Cox hazards models confirmed that HD was a significant predictor of the occurrence of major bleeding events (HR, 1.83; 1.03–3.16; p=0.04).
Moreover, researchers also found a significant negative effect of HD on the risk of all-cause mortality (HR, 2.61; 1.79–3.75; p<0.001) and major adverse cardiovascular and cerebrovascular events postdischarge (53.9 percent vs 29.3 percent; p<0.001). For instance, cardiac death (HR, 6.20; 3.18–12.1; p<0.001) and target vessel revascularization (HR, 2.60; 1.48–4.36; p=0.001) were significantly more likely in patients undergoing HD.