Key result
Dual antiplatelet therapy was the most powerful predictor of gastrointestinal bleeding in post-MI patients (adjusted HR 3.18; 95% CI 1.91-5.29).
Why the study?
What are the risk factors for gastrointestinal bleeding in post-myocardial infarction patients with left ventricular dysfunction and/or heart failure?
Observational (n=14,703)
What are the risk factors for gastrointestinal bleeding in post-myocardial infarction patients with left ventricular dysfunction and/or heart failure?
Hazard Ratio: 3.18 (95% CI 1.91–5.29)
Dual antiplatelet therapy is the strongest predictor of serious gastrointestinal bleeding in post-MI patients with LV dysfunction, an event that is associated with significantly increased mortality.
May warrant closer GI monitoring with DAPT post-MI; hypothesis-generating for bleeding-prevention trials in LV dysfunction.
AIMS: The risk of gastrointestinal (GI) bleeding limits the use of antiplatelet and anticoagulant drugs. Risk factors for GI bleeding in post- myocardial infarction (MI) patients have not been well defined. We sought to identify risk factors for GI bleeding in patients following MI. METHODS AND RESULTS: The VALsartan In Acute myocardial iNfarcTion trial (VALIANT) enrolled 14 703 post-MI patients with left ventricular dysfunction and/or heart failure and followed them for a median of 24.7 months. In the present secondary analysis, times from baseline to first GI bleeding were identified from the VALIANT serious adverse event database. Potential risk factors were explored from medical history, demographics, clinical profile, and medications, both at baseline and during follow-up. We also explored the relationship between the occurrence of GI bleeding and subsequent mortality. During follow-up, 98 (0.7%) patients had a serious GI bleeding event. These patients were older, had more comorbidities, were more likely to be taking additional antiplatelet drugs, and had worse left ventricular systolic and renal function. The Kaplan-Meier estimated rate of GI bleeding at 6 months was 0.37% (95% CI 0.27-0.47). In a multivariable Cox model, dual antiplatelet therapy was the most powerful predictor of GI bleeding, with an adjusted hazard ratio of 3.18 (95% CI 1.91-5.29). Other predictors were non-white race, history of alcohol abuse, increasing age, worse New York Heart Association class, anticoagulant therapy, diabetes, lower estimated glomerular filtration rate, and male sex. Gastrointestinal bleeding was associated with increased risk of death [adjusted hazard ratio 2.54 (95% CI 1.66-3.89)]. CONCLUSION: Following MI, clinical characteristics can identify patients with increased risk of GI bleeding. The use of dual antiplatelet agents appears to be the most profound risk factor. Whether these patients would benefit from GI prophylaxis therapy remains unknown.
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Moukarbel et al. (2009) conducted an observational in post-myocardial infarction with left ventricular dysfunction and/or heart failure (n=14,703). Dual antiplatelet therapy was evaluated on Gastrointestinal bleeding (HR 3.18, 95% CI 1.91-5.29). Dual antiplatelet therapy was the most powerful predictor of gastrointestinal bleeding in post-MI patients (adjusted HR 3.18; 95% CI 1.91-5.29).
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