Conversion and outcome of dual antiplatelet therapy after bleeding in patients with acute coronary syndrome

Abstract

Abstract Objective To explore the conversion and outcome of antiplatelet therapy in patients with acute coronary syndrome (ACS) who have suffered bleeding after receiving aspirin combined with ticagrelor. Methods Patients who diagnosed with ACS and given aspirin 100 mg once daily combined with ticagrelor 90 mg twice daily for dual antiplatelet therapy (DAPT) were selected. The patients were divided into bleeding group and non-bleeding group according to whether bleeding events occurred within one year after DAPT. The bleeding group was divided into the next four groups according to the converted antiplatelet treatment strategy decided by the doctor and the patient. Patients in group A to D were treated with ticagrelor 90mg twice a day plus aspirin 0–50mgonce a day, ticagrelor 60mg twice a day plus aspirin 100mgonce a day, clopidogrel 75mgonce a day plus aspirin 100mg once a day and ticagrelor 90mg twice a day plus aspirin 100mg once a day, respectively. All patients were followed up for 1 year after DAPT. The primary outcome is change of bleeding degree by BARC. The secondary outcomes includes BARC bleeding, all-cause mortality and MACE. Results A total of 752 cases were enrolled, including 250 in the bleeding group and 502 in the non-bleeding group. The bleeding group was divided into four treatment groups, which were 63, 43, 38 and 95 cases among A, B, C and D group. There was a significant difference in the improvement of bleeding among the four groups. To be noted, patients in group A has the highest improvement rate of hemorrhage (65.1% vs 62.8% vs 47.4% vs 24.2%, P<0.01). There were no significant differences in the incidence of MACE and all-cause mortality (P>0.05). The incidence of major MACE in patients in the bleeding group was 14.4%, which was higher than that in the non-bleeding group (9.2%, P=0.03).The result of multivariate logistic regression analysis showed that female (OR=5.18, 95% CI: 1.61–16.65, P=0.006), low body weight (OR=7.73, 95% CI: 2.46–24.49, P<0.001) and low AA-induced maximum platelet aggregation rate (OR=2.72, 95% CI:1.09–6.84, P=0.033) were independent risk factors for hemorrhage. Conclusion Patients with acute coronary syndrome who have suffered bleeding after receiving aspirin combined with ticagrelor were at a higher risk of MACE than those who did not. Low-dose aspirin (0–50mg/d) combined with ticagrelor or even ticagrelor alone has the best effect on reducing bleeding without increasing the risk of ischemia. Female, low body mass and low AA-induced maximum platelet aggregation rate are independent risk factors for bleeding. Funding Acknowledgement Type of funding source: None