Consider haemorrhage risk with dual clot therapy

The risk of haemorrhage in patients taking clopidogrel plus aspirin should be carefully considered when prescribing for cardiovascular disease, a US study suggests.

Haemorrhages were examined in patients admitted to hospital (Photograph: SPL)

The risk of acute haemorrhage from dual antiplatelet therapy (DAT) was quantified for the first time by researchers led by Nadine Shehab of the Centers for Disease Control and Prevention in Atlanta, Georgia.

The study looked at US emergency hospital admissions of patients on DAT and found 60 per cent involved some form of nose bleed or minor haemorrhage.

Although not severe, such minor bleeds are more likely to lead to early discontinuation of clopidogrel, which in turn can affect later outcomes.

The researchers said data from emergency admissions could help understand the risks of DAT outside the 'rigorous, controlled setting of clinical trials'.

They looked at the issue because of the increasing use of clopidogrel plus aspirin in place of warfarin in anticoagulation therapy.

The team analysed figures from emergency department admissions from 2006-2008, including 384 visits for patients on DAT and 2,926 visits where warfarin was taken by patients.

The rate of haemorrhage was the same as that for patients on warfarin.

Researchers estimated that, for every 815 prescriptions of DAT, one patient would be admitted to hospital with related bleeding. For every 274 patients prescribed warfarin, one would be admitted.

The overall risk of haemorrhage-related emergency admission was three times higher for warfarin than for clopidogrel plus aspirin.

The risk of hospitalisation for such visits was the same for both treatments.

Researchers concluded that the findings 'indicate that the hemorrhagic risk of clopidogrel plus aspirin therapy is substantial and suggest a need to approach that risk with vigilance'.

The high frequency of minor haemorrhages with clopidogrel plus aspirin suggest educating patients to spot such events will be important, they added.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins


Already registered?

Sign in

Just published

GP receptionist on the phone

Some practices to receive funding to upgrade digital phone systems

GP practices whose digital phone systems do not meet new NHS England standards will...

Woman using mobile phone

Safety issues with remote GP consultations 'extremely rare', study shows

Safety incidents are 'extremely rare' in remote GP consultations but risk is higher...

BMA sign

BMA urges 'courtesy and respect' ahead of talks over physician associate roles

The BMA is set for urgent talks with NHS officials over fears its call for a recruitment...

Andrea Leadsom

DHSC confirms new minister responsible for general practice

Andrea Leadsom has been confirmed as the new DHSC minister for primary care and general...


Government must match consultants' pay offer in new contract for GPs

GPs have warned they could be forced into industrial action if the government fails...

Consultants in London on strike earlier this year

Consultants to vote on new pay deal to end strikes

Consultants will vote on a government pay offer that would increase salaries by up...