title: One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Little information is available on the long-term incidence of bleeding events after ST-segment elevation myocardial infarction (STEMI) with the current antithrombotic strategy.
  
  
  OBJECTIVE
  To evaluate the effect of bleedings for up to 12months on clinical events and therapeutic compliance in unselected STEMI patients treated with prasugrel or clopidogrel.
  
  
  METHODS
  Patients were treated with clopidogrel or prasugrel according to guidelines. The primary endpoint was first occurrence of a bleeding event from hospital discharge to 12months, assessed by the Bleeding Academic Research Consortium (BARC) classification using a dedicated questionnaire. Topography of bleedings, causes of premature cessation and ischaemic events were compared between clopidogrel- and prasugrel-treated patients.
  
  
  RESULTS
  A total of 390 patients were enrolled (211 in the prasugrel group, 179 in the clopidogrel group). Elderly, female and low-body weight patients were more likely to receive clopidogrel. At 12months, the incidence of major bleedings (BARC 3) was lower with prasugrel (1% vs 6%; P=0.02), mainly due to fewer transfusions. Elderly age was a risk factor for severe bleeding. Premature treatment cessation was related to ischaemic complications (P=0.03), and occurred more frequently with prasugrel (P=0.001). One-year mortality was very low (1.9 per 100 person-years, 95% confidence interval 0.9-4.0), and was higher in the clopidogrel group (P=0.03).
  
  
  CONCLUSIONS
  In this unselected STEMI population, the rate of major bleedings with prasugrel at 12months was low, but nuisance bleedings were frequent and led to more premature cessations than with clopidogrel. Prevention of bleeding complications, even minor, is necessary to prevent disruption of antithrombotic medication.
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Lattuca
authors.affiliation: Department of epidemiology, medical statistics and public health, Caremeau university hospital, Nîmes, France; EA2415 research unit, Montpellier university, Montpellier, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Fabbro-Peray
authors.affiliation: Cardiology department, Arnaud-de-Villeneuve university hospital, Montpellier, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Schmutz
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Ledermann
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Cornillet
authors.affiliation: Emergency department, Caremeau university hospital, Nîmes, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Benezet
authors.affiliation: Cardiology department, Arnaud-de-Villeneuve university hospital, Montpellier, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.affiliation: Emergency department, Caremeau university hospital, Nîmes, France.
authors.forename: Jean-Emmanuel
authors.initials: JE
authors.lastname: de La Coussaye
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Messner-Pellenc
authors.affiliation: Cardiology department, Caremeau university hospital, place Pr-Debré, 30029 Nîmes cedex, France. Electronic address: cayla.guillaume@gmail.com.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Bleeding; Compliance; Infarctus du myocarde; Prasugrel; Real world; STEMI; Saignements; Vraie vie