title: Risk factors and outcomes for patients with vascular disease and serious bleeding events.
abstract: OBJECTIVE
  To determine the risk and outcomes of serious bleeding events in patients with atherosclerotic vascular disease or risk factors.
  
  
  METHODS
  68 375 outpatients with prior ischaemic vascular events or multiple atherosclerotic risk factors were followed in this prospective observational study; 64 977 had 1-year follow-up data. Main outcome measures were rates of serious bleeding events and 1-year outcomes for patients with and without serious bleeding events.
  
  
  RESULTS
  The 1-year rate of serious haemorrhage was 0.92%, with a cerebral haemorrhage rate of 0.11%. Patients with symptomatic vascular disease had a haemorrhage rate of 1.0%, compared with 0.59% in those with risk factors only. Risk factors for serious bleeding included age, smoking, hypertension, diabetes, congestive heart failure, use of antithrombotics and polyvascular disease. Bleeding risk increased with the use of anticoagulants (OR 1.99, 95% CI 1.38 to 2.86, p<0.001) or antiplatelet agents combined with anticoagulants (OR 2.54, 95% CI 1.74 to 3.71, p<0.001). By logistic regression analysis, patients with a serious bleed (excluding cerebral haemorrhage) had a more than threefold increased risk (HR 3.25, 95% CI 2.58 to 4.10, p<0.0001) of a significant vascular outcome (myocardial infarction, stroke, vascular death) compared with patients without a serious bleed.
  
  
  CONCLUSIONS
  Serious bleeding complications were relatively rare, but significant considering the large population at risk. Predictors of increased bleeding were similar to the risk factors for ischaemic events. Patients who experienced a serious bleed had a significantly higher rate of major vascular events.
authors.affiliation: Department of Neurology, Northwestern University Feinberg School of Medicine, 710N Lake Shore Drive, Room 1420, Chicago, IL 60611, USA. m-alberts@northwestern.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Joachim
authors.initials: J
authors.lastname: Röther
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Alan T
authors.initials: AT
authors.lastname: Hirsch
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D001161:Arteriosclerosis / Q000150:complications* / Q000628:therapy; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007511:Ischemia / Q000209:etiology; D010045:Outpatients; D011446:Prospective Studies; D012307:Risk Factors