Hemorrhage-related adverse events from clopidogrel plus aspirin

January 01, 0001

Hemorrhage-related adverse events from clopidogrel plus aspirin

Dual antiplatelet therapy (DAT) with clopidogrel plus aspirin is a well-established antithrombotic strategy, with hemorrhage being the chief adverse event (AE) of concern. These US authors sougth to estimate the numbers and rates of emergency department (ED) visits for hemorrhage-related AEs (hemorrhage or evaluation for potential hemorrhage) from DAT in the United States and put them in the context of those from warfarin. They analyzed AEs from a national database, 2006-2008, and outpatient prescribing from national survey data, 2006-2007.

They found: "Based on 384 cases, there were an estimated 7654 ED visits annually for hemorrhage-related AEs from DAT compared with 2926 cases and an estimated 60,575 ED visits from warfarin. Approximately 60% of ED visits for DAT consisted of epistaxis or other minor hemorrhages (eg, bleeding from small cuts). The risk of hospitalization for ED visits involving acute hemorrhages was not significantly different between DAT and warfarin. The estimated rate of ED visits involving acute hemorrhages from DAT was 1.2 per 1000 outpatient prescription visits vs 2.5 per 1000 outpatient prescription visits for warfarin (risk ratio, 0.49; significant)."

The authors concluded: "These findings indicate that the acute hemorrhagic risk with DAT is clinically significant and reinforce the importance of practitioners and patients recognizing and anticipating this risk."

The lower rate of ED visits with clopidogrel plus aspirin along with less complex management may tip the balance in favor of clopidogrel plus aspirin.

For the full abstract, click here.

Arch Intern Med 170(21):1926-1933, 22 November 2010
© 2010 to the American Medical Association
National Estimates of Emergency Department Visits for Hemorrhage-Related Adverse Events From Clopidogrel Plus Aspirin and From Warfarin. Nadine Shehab, Laurence S. Sperling, Scott R. Kegler, Daniel S. Budnitz. Correspondence to Dr. Shehab: nshehab@cdc.gov

Category: B. Blood/Blood Forming Organs/Immune Mechanisms. Keywords: dual antiplatelet therapy, aspirin, clopidogrel, warfarin, adverse events, hemorrhage, hospitalization, emergency department visits, population- based observational study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 14 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.