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Differential propensity for major hemorrhagic events in patients with different types of arterial disease

S Achterberg1, F L J Visseren, L J Kappelle

  • 1Department of Neurology, Utrecht Stroke Center, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands. s.achterberg-2@umcutrecht.nl

Journal of Thrombosis and Haemostasis : JTH
|July 15, 2011
PubMed

Insights

Patients with cerebrovascular disease (CVD) or peripheral arterial obstructive disease (PAD) face a higher risk of major bleeding events than those with coronary artery disease (CAD). This increased risk is not explained by common risk factors or genetic variations.

Area of Science:

  • Cardiovascular Medicine
  • Hemorrhagic Complications
  • Atherosclerosis Research

Background:

  • Atherosclerosis is a primary cause of coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral arterial obstructive disease (PAD).
  • Previous findings indicated a two-fold higher risk of major hemorrhagic complications in patients with CVD or PAD compared to those with CAD.

Purpose of the Study:

  • To investigate whether the elevated risk of major hemorrhagic complications in CVD/PAD patients versus CAD patients is due to baseline risk factors or genetic variants in hemostasis.
  • To identify the underlying causes for differential bleeding risks among atherosclerosis subtypes.

Main Methods:

  • A cohort of 2622 patients with non-disabling CAD, CVD, or PAD was followed for a mean of 6.6 years.
  • Major hemorrhagic complications, including intracranial, fatal, and hospitalization-requiring events, were recorded.
  • Statistical analysis included hazard ratios adjusted for baseline characteristics and genetic variants.

Main Results:

  • Major hemorrhagic complications occurred in 122 patients (0.77% annual event rate).
  • Patients with CVD or PAD exhibited a significantly higher risk of major hemorrhagic complications compared to CAD patients (HR 2.05).
  • This disparity was not explained by hypertension, diabetes, renal failure, antithrombotic use, or genetic variants.

Conclusions:

  • Patients with CVD or PAD have a substantially higher risk of major hemorrhagic events than those with CAD.
  • Known risk factors, antithrombotic therapies, and genetic hemostasis variants do not account for this observed difference.
  • Further research is essential to elucidate the reasons behind this risk differential and explore potential variations in pathogenesis.
Abstract

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