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Risk factors for acute gastrointestinal bleeding following myocardial infarction in veteran patients who are prescribed clopidogrel
Author(s) -
Cuschieri Justin R,
Drawz Paul,
FalckYtter Yngve,
Wong Richard C K
Publication year - 2014
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12123
Subject(s) - medicine , clopidogrel , warfarin , gastrointestinal bleeding , myocardial infarction , atrial fibrillation , kidney disease , renal function , gastroenterology , aspirin , stroke (engine) , mechanical engineering , engineering
Objective Our aim was to identify risk factors for acute gastrointestinal (GI) bleeding in patients with myocardial infarction (MI) who were prescribed clopidogrel following hospital discharge. Methods Data were collected retrospectively from patients treated in V eteran A ffairs hospitals in Ohio, USA, from 2001 to 2008 with a primary diagnosis of MI ( I nternational C lassification of D iseases, 9th R evision) and a prescription for clopidogrel filled within 48 h of discharge. Primary outcome was acute GI bleeding after discharge. Results Acute GI bleeding occurred in 107 of 3218 patients. Bleeding occurred in those who were elder (66.2 vs 62.4 years, P = 0.0002), had lower glomerular filtration rate (74 vs 81 mL/min, P = 0.024), had filled prescription for warfarin (15.9% vs 6.9%, P = 0.0004), diagnosed as atrial fibrillation (20.6% vs 11.1%, P = 0.003), chronic liver (5.6% vs 2.2%, P = 0.018) or kidney disease (29.0% vs 19.4%, P = 0.016). A risk model and GI bleed risk score were developed and showed that patients with age >65 years, use of warfarin, the presence of chronic liver or kidney disease were at increased risk for GI bleeding. Conclusions Veterans patients of advanced age, using warfarin and with chronic liver and kidney disease may be at increased risk of GI bleeding when prescribed clopidogrel following MI. A scoring system may help to identify patients at high risk for GI bleeding.