[MO-48] Presentation Awards
Incidence, predictors, and prognostic implications of hospitalization for late bleeding after endovascular therapy
BACKGROUND:Platelet inhibition after endovascular therapy (EVT) reduces the risk of major adverse limb event (MALE), but increases the risk of bleeding. The incidence of late major bleeding after EVT, its independent predictors, and its prognostic importance in clinical practice has not been fully addressed.
METHODS AND RESULTS:We evaluated consecutive 834 patients who underwent EVT in Yokosuka Kyosai Hospital. Cox proportional hazard models were used to determine factors associated with late major bleeding, which was defined as hospitalization for bleeding after discharge from the index EVT, and to estimate risk of death associated with late bleeding. We found that 90 patients (10.8%) were hospitalized for major bleeding in median time of 27 months follow-up after EVT, with most of bleeding episodes due to gastrointestinal bleed. The significant predictor of late major bleeding was hemodialysis (hazard ratio [HR], 4.82; 95% confidence interval [CI], 2.15 to 10.83; p<0.001) and dual antiplatelet therapy use at follow-up (HR, 2.76; 95% CI, 0.92 to 8.23; p=0.026). At the median follow-up of 27 months (13-47 months), all-cause mortality-free survival rate was significantly worse in patients with major bleeding experienced group than non-major bleeding experienced group (long-rank test χ2=102.9; p<0.001). Cox proportional hazards analysis showed hospitalization due to major bleeding (HR, 3.75; 95% CI, 2.68 to 5.25; p<0.001) was an independent predictor of all-cause death after EVT.
CONCLUSIONS:Hospitalization for late major bleeding after EVT is associated with substantially increased risk of death even after successful EVT. The hemodialysis is associated with the highest risk of late bleeding.
METHODS AND RESULTS:We evaluated consecutive 834 patients who underwent EVT in Yokosuka Kyosai Hospital. Cox proportional hazard models were used to determine factors associated with late major bleeding, which was defined as hospitalization for bleeding after discharge from the index EVT, and to estimate risk of death associated with late bleeding. We found that 90 patients (10.8%) were hospitalized for major bleeding in median time of 27 months follow-up after EVT, with most of bleeding episodes due to gastrointestinal bleed. The significant predictor of late major bleeding was hemodialysis (hazard ratio [HR], 4.82; 95% confidence interval [CI], 2.15 to 10.83; p<0.001) and dual antiplatelet therapy use at follow-up (HR, 2.76; 95% CI, 0.92 to 8.23; p=0.026). At the median follow-up of 27 months (13-47 months), all-cause mortality-free survival rate was significantly worse in patients with major bleeding experienced group than non-major bleeding experienced group (long-rank test χ2=102.9; p<0.001). Cox proportional hazards analysis showed hospitalization due to major bleeding (HR, 3.75; 95% CI, 2.68 to 5.25; p<0.001) was an independent predictor of all-cause death after EVT.
CONCLUSIONS:Hospitalization for late major bleeding after EVT is associated with substantially increased risk of death even after successful EVT. The hemodialysis is associated with the highest risk of late bleeding.