Definition, Incidence, Correlates, and Clinical Impact of “Nuisance” Bleeding in Patients Undergoing Drug-Eluting Stent Implantation

Abstract

"Nuisance" bleeding, or superficial bleeding, after antiplatelet therapy is not well characterized despite its potential to affect patient compliance and premature cessation of oral antiplatelet therapy, which can lead to clinical events, such as stent thrombosis. In contrast to major, moderate, or minor bleeding, nuisance bleeding has never been included in the primary or secondary end points of antiplatelet and antithrombin trials and was not reported as an in-hospital or follow-up event in the pivotal pharmacology or device trials associated with percutaneous coronary intervention. Currently, the incidence and impact of these bleeds are not officially recorded and remain unknown. Indeed, there are challenges in the definition, in the acquisition of consistent phenomenon characteristics, and its attribution to major clinical adverse events. Nuisance bleeding is commonly seen in patients on dual antiplatelet therapy. It may be the cause of premature cessation of oral antiplatelet therapy, which is detrimental to prognosis after drug-eluting stent implantation. This article discusses the various definitions, incidence, correlates, and clinical impact of this phenomenon.