Patients with heart stents have similar increased risk of death from bleeding and heart attacks

April 8, 2015 by Scott Maier, University of California, San Francisco
Myocardial Infarction or Heart Attack. Credit: Blausen Medical Communications/Wikipedia/CC-A 3.0

In patients who received a stent to treat coronary artery blockage, those who experienced bleeding requiring hospitalization in the years after the procedure faced an increased risk of death that was similar to the risk faced by those who subsequently had heart attacks, according to a study of nearly 33,000 patients by UC San Francisco and Kaiser Permanente.

"Every year, 600,000 patients in the United States receive a and are given drugs that prevent the formation of clots within the stent. These drugs prevent heart attacks but increase the risk of ," said lead author Dhruv Kazi, MD, MSc, MS, an assistant professor of medicine at UCSF. "These bleeds are often written off as a side effect, but it turns out that they may be just as bad for patients as the heart attacks we're trying to avoid."

The study in the April 14 issue of the Journal of the American College of Cardiology is the first to show that the two risks are of comparable magnitude.

Kazi said that the results underline the importance of treating cardiac patients based on personalized risk factors, instead of using what he called a "one-size-fits-all" approach based on population statistics. This study points toward the possibility of using other information about patients that may help identify the antiplatelet drug that is most likely to be the most safe and effective for individual patients in the long run.

The study authors analyzed the records of 32,906 patients in the Kaiser Permanente Northern California health care system who received stents between 1996 and 2008 and were followed for four years. They found that both post-procedure and episodes of bleeding requiring hospitalization were associated with a greater relative risk of death (91 percent and 61 percent, respectively) over the same time span. The risks in the two groups were not different statistically, so the researchers could not say the risk for one was greater than the other.

Senior author Alan S. Go, MD, of the Kaiser Permanente Division of Research, noted that the study results "highlight the need for and value of high-quality outcomes research using data from patients treated in the real world to inform patients and doctors about the consequences of treatments."

Randomized trials, Go observed, "can tell us whether or not a drug, such as an antiplatelet medication, works. But patients enrolled in these trials are highly selected and may not really be like the we treat in the clinical practice and are usually followed for a short period of time."

In contrast, Go said, when rigorously evaluated, data collected in everyday clinical practice can yield valuable insights about long-term effectiveness and safety that complement what is learned from .

"We've known for some time that bleeds that occur during the stent procedure are bad for the patient, so we increasingly take steps to reduce those bleeds, such as giving drugs with lower bleeding risk and using the radial artery to perform the procedure instead of the femoral artery," Kazi said. "This is the first study to show that bleeds that occur in the months and years after discharge are also bad for the patient, emphasizing the need for long-term strategies that reduce a patient's risk of bleeding."

Explore further: Duration of antiplatelet therapy following PCI, risk of adverse events

Related Stories

Duration of antiplatelet therapy following PCI, risk of adverse events

March 17, 2015
An additional 18 months of dual antiplatelet therapy among patients who received a bare metal coronary stent did not result in significant differences in rates of stent thrombosis (formation of a blood clot), major adverse ...

Heart bypass surgery outperforms new generation stents

March 16, 2015
Despite the advent of a new generation of stents, patients with multiple narrowed arteries in the heart who received coronary artery bypass grafting fared better than those whose arteries were opened with balloon angioplasty ...

No mortality benefit of bypass surgery compared to latest generation of drug-coated stents

March 16, 2015
Newer drug-coated stents that keep arteries open have similar long-term rates of death compared with traditional bypass surgery for patients with more than one diseased coronary artery.

Complete angioplasty safe for certain heart attack survivors

March 17, 2015
Patients who experience the deadliest form of heart attack—ST segment elevation myocardial infarction (STEMI)—and suffer from substantial narrowing in multiple heart arteries may benefit from receiving angioplasty in ...

Anticoagulant linked with lower risk of death following heart attack compared to heparin

February 17, 2015
Patients who experienced a certain type of heart attack who received the anticoagulant fondaparinux had a lower risk of major bleeding events and death both in the hospital and after six months compared to patients who received ...

Extended post-stent treatment reduces risk of coronary thrombosis

November 17, 2014
Patients who took two anti-clotting medications beyond the standard 12 months after stent placement were significantly less likely to develop blood clots within their stents or to have a heart attack than those whose treatment ...

Recommended for you

'Smart stent' detects narrowing of arteries

June 19, 2018
For every three individuals who have had a stent implanted to keep clogged arteries open and prevent a heart attack, at least one will experience restenosis—the renewed narrowing of the artery due to plaque buildup or scarring—which ...

Marriage may protect against heart disease / stroke and associated risk of death

June 18, 2018
Marriage may protect against the development of heart disease/stroke as well as influencing who is more likely to die of it, suggests a pooled analysis of the available data, published online in the journal Heart.

Deaths from cardiac arrest are misclassified, overestimated

June 18, 2018
Forty percent of deaths attributed to cardiac arrest are not sudden or unexpected, and nearly half of the remainder are not arrhythmic—the only situation in which CPR and defibrillators are effective—according to an analysis ...

Tick-borne meat sensitivity linked to heart disease

June 15, 2018
University of Virginia School of Medicine researchers have linked sensitivity to an allergen in red meat—a sensitivity spread by tick bites—with a buildup of fatty plaque in the arteries of the heart. This buildup may ...

Tobacco aside, e-cigarette flavorings may harm blood vessels

June 14, 2018
Flavor additives used in electronic cigarettes and related tobacco products could impair blood vessel function and may be an early indicator of heart damage, according to new laboratory research in Arteriosclerosis, Thrombosis ...

The molecules that energize babies' hearts

June 14, 2018
A metabolic process that provides heart muscle with energy fails to mature in newborns with thickened heart walls, according to a Japan–Canada research team.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.