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Blood pressure levels and bleeding events during antithrombotic therapy: the Bleeding with Antithrombotic Therapy

Kazunori Toyoda1, Masahiro Yasaka, Shinichiro Uchiyama

  • 1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. toyoda@hsp.ncvc.go.jp

Stroke
|May 22, 2010
PubMed

Insights

Elevated blood pressure (BP) during antithrombotic therapy increases intracranial hemorrhage (ICH) risk. Maintaining BP below 130/81 mm Hg is crucial for preventing ICH in these patients.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Antithrombotic medications are widely used for cardiovascular and cerebrovascular diseases.
  • Major bleeding events, including intracranial hemorrhage (ICH) and extracranial hemorrhage, are significant risks associated with antithrombotic therapy.
  • The relationship between blood pressure (BP) levels during follow-up and the risk of bleeding events requires further clarification.

Purpose of the Study:

  • To investigate the association between BP levels during follow-up and the occurrence of major bleeding events (ICH and extracranial hemorrhage) in patients using oral antithrombotic agents.
  • To identify specific BP thresholds or trends associated with an increased risk of bleeding.

Main Methods:

  • A prospective, multicenter, observational cohort study involving 4009 patients on oral antithrombotic agents.
  • Assessment of changes in systolic and diastolic BP from entry to the last clinic visit before a bleeding event.
  • Statistical analysis to determine the association between BP levels and the incidence of ICH and extracranial hemorrhage, adjusting for known predictors.

Main Results:

  • Over a median follow-up of 19 months, 31 patients developed ICH and 77 developed extracranial hemorrhage.
  • Elevated systolic and diastolic BP levels during follow-up, particularly in the first year, were independently associated with an increased risk of ICH.
  • An optimal BP cutoff of >=130/81 mm Hg was identified for predicting ICH risk.
  • No significant association was found between BP levels and extracranial hemorrhage.

Conclusions:

  • An increase in BP during antithrombotic medication is positively associated with the development of ICH.
  • Adequate BP control, aiming for levels below 130/81 mm Hg, is important for preventing ICH in patients on antithrombotic therapy.
  • BP levels do not appear to be associated with the risk of extracranial hemorrhage in this patient population.
Abstract

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