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Risk factors and outcomes for patients with vascular disease and serious bleeding events

Mark J Alberts1, Deepak L Bhatt, Sidney C Smith

  • 1Department of Neurology, Northwestern University Feinberg School of Medicine, 710N Lake Shore Drive, Room 1420, Chicago, IL 60611, USA. m-alberts@northwestern.edu

Heart (British Cardiac Society)
|July 1, 2011
PubMed

Insights

Serious bleeding events in patients with atherosclerotic vascular disease are uncommon but linked to higher risks of major vascular events. Key predictors of bleeding include age, smoking, and certain medications.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Epidemiology

Background:

  • Atherosclerotic vascular disease (ASVD) affects a large population, necessitating understanding of associated risks.
  • Serious bleeding is a known complication, but its precise incidence and impact in ASVD patients require further elucidation.

Purpose of the Study:

  • To investigate the incidence and outcomes of serious bleeding events in a large cohort of patients with ASVD or risk factors.
  • To identify predictors of serious bleeding and its association with subsequent major vascular events.

Main Methods:

  • Prospective observational study of 68,375 outpatients with prior ischemic vascular events or multiple atherosclerotic risk factors.
  • Follow-up data for 64,977 patients, with main outcome measures including rates of serious bleeding and 1-year outcomes.

Main Results:

  • The 1-year incidence of serious hemorrhage was 0.92% (cerebral hemorrhage 0.11%).
  • Patients with symptomatic ASVD had higher hemorrhage rates (1.0%) than those with risk factors only (0.59%).
  • Predictors included age, smoking, hypertension, diabetes, heart failure, antithrombotics, and polyvascular disease. Anticoagulant and dual antiplatelet/anticoagulant use significantly increased bleeding risk.
  • Serious bleeding (excluding cerebral) was associated with a >3-fold increased risk of major vascular outcomes (myocardial infarction, stroke, vascular death).

Conclusions:

  • Serious bleeding complications in ASVD patients are relatively rare but carry significant implications due to the large at-risk population.
  • Bleeding predictors overlap with those for ischemic events, highlighting shared risk factors.
  • Experiencing a serious bleed substantially elevates the risk of major vascular events, underscoring the need for careful risk-benefit assessment in treatment strategies.
Abstract

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