CardioSource WorldNews December 2014 - Page 47

Editor’s Note: This story is also running as the cover story of CardioSource WorldNews: Interventions. The topic of aspirin use in a variety of settings, and of its utility, is of interest to the broader universe of cardiologists. We’ve included the article in this issue for this reason. prior to the procedure,” said that study’s senior author, Hitinder Gurm, MD, in an interview. “In almost all patients, we should be able to get aspirin on board before we take them to the lab,” he added. Dr. Gurm, who is from the University of Michigan Medical Center in Ann Arbor, thinks aspirin needs to be part of the pre-procedure “time-out” checklist. The Two Sides of Aspirin and Warfarin in Stable CAD The use of aspirin in secondary prevention in patients with established vascular disease is strongly supported by current guidelines due to its ability to produce a 25% reduction in the risk of cardiovascular death, MI, or stroke.4 Martial Hamon, MD, and colleagues at the Centre Hospitalier Universitaire de Caen in France recently looked at the little-studied prognostic impact of major bleeding in outpatients with stable coronary artery disease (CAD).5 While the deleterious effects of major bleeding in the setting of PCI has received tons of attention of late, few have studied the relatively rare phenomenon of major bleeding in an otherwise stable CAD patient. In the CORONOR (Suivi d’une cohorte de patients COROnariens stables en region NORd-Pasde-Calais) registry, Hamon and colleagues prospectively enrolled 4,184 CAD patients who were at least 1 year past any MI or coronary revascularization. The good news: during 2 years of follow-up, patients experienced only 51 major bleeding events, yielding a rate of 0.6% per year. Most were gastrointestinal bleeds (54.9%), with 19.6% being intracranial. Most of the bleeding events were classified as Bleeding Academic Research Consortium (BARC) type 3a bleeds, with 12 fatal bleeds (BARC type 5). The usual list of suspects appeared as predictors of major bleeding: older age, diabetes, renal failure, and warfarin use. However, in the case of warfarin (the strongest predictor with a hazard ratio (HR) of 4.69; p <0.0001), the increased risk of bleeding was only evident in patients who received a combination of warfarin and aspirin (VKA + APT in FIGURE 2). There was no significant increase in bleeding in patients on warfarin alone. Here’s where things start getting m