Thromb Haemost 2018; 118(06): 1101-1112
DOI: 10.1055/s-0038-1646923
Atherosclerosis and Ischaemic Disease
Schattauer GmbH Stuttgart

Predictors of Bleeding in Patients with Symptomatic Peripheral Artery Disease: A Cohort Study Using The Health Improvement Network in the United Kingdom

Lucía Cea Soriano
1  Department of Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
2  Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
,
F. Gerry R. Fowkes
3  Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
,
Alaster M. Allum
4  Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
,
Saga Johansson
4  Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden
,
Luis A. García Rodriguez
1  Department of Pharmacoepidemiology, Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain
› Author Affiliations
Funding This work was supported by AstraZeneca. Medical writing support was provided by Dr Anja Becher of Oxford PharmaGenesis, Oxford, UK, and was funded by AstraZeneca.
Further Information

Publication History

09 January 2018

28 March 2018

Publication Date:
27 April 2018 (eFirst)

Abstract

The purpose of this analysis was to assess potential predictors of intra-cranial bleeding (ICB) and gastrointestinal bleeding (GIB) in patients with symptomatic peripheral artery disease (PAD) in UK primary care. Patients with symptomatic PAD diagnosed from 2000 to 2010 were identified from The Health Improvement Network (THIN; N = 28,484). A nested case–control analysis, adjusted for potential confounders, was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for potential predictors of ICB or GIB. For GIB, follow-up was restricted to Hospital Episode Statistics-linked THIN practices. Median follow-up was 6 years. For ICB (153 cases), the OR (95% CI) was 3.85 (1.33–11.13) for previous ICB, 0.90 (0.61–1.34) for treated hypertension, 1.59 (0.65–3.87) for untreated hypertension and 1.38 (0.80–2.36) for current smoking. ORs for ICB were 0.78 (0.50–1.21), 0.40 (0.09–1.82) and 1.27 (0.47–3.47) with use of acetylsalicylic acid (ASA), clopidogrel and warfarin monotherapy, respectively, compared with non-use of such therapy. For GIB (506 cases), the OR was 1.40 (1.05–1.86) for peptic ulcer disease, 3.20 (1.81–5.64) for dual anti-platelet therapy use, 1.96 (1.46–2.64) for non-steroidal anti-inflammatory drug (NSAID) use and 1.01 (0.80–1.28) for proton pump inhibitor use. ORs for GIB were 1.78 (1.39–2.30), 2.03 (1.05–3.93) and 1.25 (0.72–2.16) with ASA, clopidogrel and warfarin monotherapy, respectively, compared with non-use. Previous ICB was a risk factor for ICB. Use of anti-platelet therapy or NSAIDs increased GIB risk. Identifying bleeding predictors could help optimize treatment strategies for patients with PAD.