Peng Wenxing, Shi Xiujin, Xu Xiaoyu, Zhou Yang, Zhang Yi, Lin Yang
Objective To explore the occurrence and risk factors of bleeding events in acute coronary syndromes (ACS) patients treated with ticagrelor combined with aspirin. Methods The study subjects were selected from ACS patients who were admitted to Beijing Anzhen Hospital, Capital Medical University from January to December 2017 and treated with ticagrelor and aspirin (aspirin 100-mg/d, ticagrelor 180-mg/d). Medical records of the patients who met the inclusion criteria(at age>18 years, with medication duration ≥ 1 year, and with complete follow-up records) were collected and retrospectively analyzed. The patients were divided into bleeding group and non-bleeding group according to whether there were bleeding events within 1 year. Baseline clinical characteristics such as gender, age, type of ACS, comorbidities, combined drugs, history of percutaneous coronary intervention, routine blood parameters, liver and kidney function, and etc. in patients between 2 groups were compared. The risk factors of bleeding events were analyzed using logistic regression method and the odds ratio (OR) and its 95% confidence interval (CI) were calculated. Results A total of 180 patients were entered in the analysis, including 135 males and 58 females, aged （57±10） years, with the range of 31 to 81 years. There were 39 patients in the bleeding group and 141 patients in the non-bleeding group, and the incidence of bleeding events was 21.7%. None of the differences in gender distribution, age, comorbidities, history of percutaneous coronary intervention or combined drugs in patients between the 2 groups were statistically significant (all P>0.05). The platelet count of patients in the bleeding group was significantly lower than that in the non-bleeding group ［(197±49) ×109/L vs. (220±60) ×109/L, t=2.254, P=0.025］. The shortest time from medication to the onset of bleeding of the 39 patients in the bleeding group was 14 days and the longest one was 12 months. The cumulative incidences of bleeding events at 3, 6, and 12 months of medication were 12.2% (22/180), 18.3% (33/180), and 21.7% (39/180), respectively. All bleeding events were minor bleeding, and the skin mucous ecchymosis had the highest incidence, which was 15.0% (27/180), followed by gingival bleeding or nosebleed, which was 7.2% (13/180). The incidence of fundus hemorrhage was 1.7% (3/180) and incidences of gastrointestinal bleeding and hematuria were both 0.6% (1/180). Multivariate logistic regression analysis showed that low platelet count was an independent risk factor for bleeding events ［OR=0.991, 95%CI: 0.984-0.999, P=0.020］. Conclusions ACS patients have a relative high risk of bleeding events when treated with ticagrelor combined with aspirin, but most of them were minor. For ACS patients with low platelet counts, this anti- platelet regimen should be used with caution and drug monitoring should be done in the whole course.
