The MD Conference Express ISTH Special Collection - (Page 22)
SELECTEd UpdATES ON BLEEdING rISK
Balancing Bleeding and Ischemic
Risk in the Acute and Long-Term Setting
AHA 2012, Written by Toni Rizzo
TRITON TImI-38 STUDY
Elliott Antman, MD, Harvard Medical School, Boston, Massachusetts, USA, discussed issues
in balancing the treatment of ischemic risk with bleeding associated with anticoagulant and
antiplatelet therapies. The TRITON TIMI-38 study evaluated the time dependence of the
association of bleeding with mortality in ACS patients undergoing planned percutaneous
coronary intervention (PCI) [Hochholzer W et al. Circulation 2011]. A total of 13,608 patients were
treated with aspirin and randomized to clopidogrel (300 mg loading dose/75 mg maintenance dose)
or prasugrel (60 mg loading dose/10 mg maintenance dose) for a median duration of 14.5 months.
The TRITON TIMI-38 safety cohort consisted of 13,420 patients, excluding patients who
experienced coronary artery bypass grafting-related bleeding. Among this cohort, 534 (4%) had
a serious bleeding event (TIMI major or minor bleeding). A novel biostatistical approach for
the analysis employed a multivariable Cox model including treatment, baseline and procedural
variables, and a propensity score for bleeding. Multiple iterative landmark analyses were conducted
from Day 1 up to Day 180 after the bleeding event. Observation showed that HRs for serious bleeding,
spontaneous serious bleeding, and instrumental or traumatic serious bleeding were initially high
but dropped sharply over time (Figure 1). The HR did not differ statistically from baseline risk by 40
days after the bleeding event.
Figure 1. Hazard Ratios and 95% Confidence Intervals for Bleeding Events.
8
Confidence Intervals
7
Hazard Ratio
Serious Bleeding
6
5
4
3
Select Peer-Reviewed
Highlights on Thrombosis
and Haemostasis
From 2012
2
1
0
0
8
30
60
Days After Bleeding Event
90
Spontaneous Serious Bleeding
7
6
5
4
3
2
1
0
0
8
30
60
Days After Bleeding Event
90
Instrumented or Traumatic Serious Bleeding
7
6
5
4
3
2
1
0
0
30
60
Days After Bleeding Event
90
Hochholzer W et al. Circulation 2012;123(23):2681-2689.
22
May 2013
www.mdconferencexpress.com
http://www.mdconferencexpress.com
Table of Contents for the Digital Edition of The MD Conference Express ISTH Special Collection
The MD Conference Express ISTH Special Collection
Table of Contents
New Oral Anticoagulants and Antiplatelet Drugs
SPS3 Study Does Not Support the Use of Combination Therapy for Stroke Prevention
Apixaban Superior to Warfarin in Patients with Atrial Fibrillation as Well as Prior Stroke or TIA
The HOST-ASSURE Randomized Trial
Oral Rivaroxaban Alone for Symptomatic Pulmonary Embolism
Moderate PE Treated with Thrombolysis (MOPETT Study)
Results of the WOEST Trial
Genetic Determinants of Variability in Dabigatran Exposure
Rivaroxaban of Benefit in STEMI: ATLAS ACS 2-TIMI 51
Hyporesponsiveness to Clopidogrel Does Not Predict 1-Year Mortality
First Large-Scale Platelet Function Evaluation in an Acute Coronary Syndrome Trial: The Trilogy ACS-Platelet Function Substudy
ASPIRE: Using Aspirin to Prevent Recurrence of VTE
ARCTIC: Randomized Trial of Bedside Platelet Function Monitoring
Long-Term Dabigatran Extension Study for Stroke Prevention in Treatment for Atrial Fibrillation
Clopidogrel Plus Aspirin Reduces Risk of Recurrent Stroke: The CHANCE Trial
Anticoagulation and Antithrombotic Therapy in Atrial Fibrillation
Balancing Bleeding and Ischemic Risk in the Acute and Long-Term Setting
Safety and Efficacy of Anticoagulants
The MD Conference Express ISTH Special Collection
https://www.nxtbook.com/nxtbooks/md_conference_express/ISTH
https://www.nxtbookmedia.com