Comparison of bleeding complications between patients with peripheral and coronary artery disease after revascularization: Insights from ASPARAGUS, a prospective observational study

Introduction: This study compared the risks and incidences of major bleeding between patients undergoing revascularization for peripheral (PAD) and coronary artery disease (CAD). Methods: A subanalysis of the ASPARAGUS study ( AS sessment of P rognosis in P A tients with Co R onary or Peripheral A rtery Disease Under G oing Perc U taneou S or Surgical Intervention) was conducted to compare the incidence of bleeding complications between patients with PAD and CAD. Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria were applied in 4343 patients with PAD and 6238 with CAD, respectively. The primary study endpoint was the cumulative incidence of major bleeding, defined as Bleeding Academic Research Consortium types 3 and 5. Results: At least one major bleeding criterion and one minor bleeding criterion were found in 61.5% and 79.3% of patients with PAD, compared with 32.0% and 65.9% of patients with CAD, respectively. During a median follow-up of 27.4 months, 385 incidences of major bleeding were recorded. In the PAD group, the crude incidence rate of major bleeding was 19.1 per 1000 person-years, which was higher than the 10.7 per 1000 person-years in the CAD group. Multivariable Poisson regression analysis demonstrated that PAD versus CAD was not significantly associated with incident major bleeding after adjusting for ARC-HBR major and minor criteria (adjusted incidence risk ratio = 1.14, 95% CI, 0.93–1.40; p = 0.22). Conclusion: Patients with PAD had higher ARC-HBR scores and a higher incidence rate of major bleeding than those with CAD. Their higher risk of major bleeding was driven by their higher prevalence of ARC-HBR-defined risk factors.