title: Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.
abstract: BACKGROUND
  Bleeding among patients with acute myocardial infarction (AMI) is associated with worse long-term outcomes. Although the mechanism underlying this association is unclear, a potential explanation is that withholding antiplatelet therapies long beyond resolution of the bleeding event may contribute to recurrent events.
  
  
  RESULTS
  We examined medication use at discharge, 1, 6, and 12 months after AMI among 2498 patients in the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) registry. Bleeding was defined as non-coronary artery bypass graft-related Thrombolysis of Myocardial Infarction major/minor bleeding or transfusion among patients with baseline hematocrit > or =28%. Logistic regression was used to evaluate the association between bleeding during the index AMI hospitalization and medication use. In-hospital bleeding occurred in 301 patients (12%) with AMI. Patients with in-hospital bleeding were less likely to be discharged on aspirin or thienopyridine (adjusted odds ratio=0.45; 95% CI, 0.31 to 0.64; and odds ratio=0.62; 95% CI, 0.42 to 0.91, respectively). At 1 month after discharge, although patients with in-hospital bleeding remained significantly less likely to receive aspirin (odds ratio=0.68; 95% CI, 0.50 to 0.92), use of thienopyridines in the 2 groups started to become similar. By 1 year, antiplatelet therapy use was similar among patients with and without bleeding. Postdischarge cardiology follow-up was associated with greater antiplatelet therapy use than either primary care or no clinical follow-up.
  
  
  CONCLUSIONS
  Patients whose index AMI is complicated by bleeding are less likely to be treated with antiplatelet therapies during the first 6 months after discharge. Early reassessment of antiplatelet eligibility may represent an opportunity to reduce the long-term risk of adverse outcomes associated with bleeding.
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705, USA. wang0085@mc.duke.edu
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: Lan
authors.initials: L
authors.lastname: Xiao
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Mikhail N
authors.initials: MN
authors.lastname: Kosiborod
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit; D006470:Hemorrhage / Q000139:chemically induced*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects*; D012042:Registries; D012044:Regression Analysis
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D001241:Aspirin