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Bleeding After Hospital Discharge Following Acute Coronary Syndrome: Incidence, Types, Timing, and Predictors

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journal contribution
posted on 21.05.2020, 11:02 by Nafiu Ismail, Kelvin P Jordan, Umesh T Kadam, John J Edwards, Tim Kinnaird, Mamas A Mamas
Background: The incidence and predictors of bleeding after acute coronary syndrome are unclear within the real-world setting. Our objective was to determine the incidence, types, timing, and predictors of bleeding complications following hospital discharge after acute coronary syndrome. Methods and Results: We used the Clinical Practice Research Datalink, with linkage to Hospital Episode Statistics, to determine the incidence, timing, and types of bleeding events within 12 months after hospital discharge for acute coronary syndrome. We assessed independent associations between postdischarge bleeding and baseline patient characteristics using a competing risk regression model, accounting for death as a competing event. Among 27 660 patients surviving to hospital discharge, 3620 (13%) experienced bleeding complications at a median time of 123 days (interquartile range, 45–223 days) after discharge. The incidence of bleeding was 162/1000 person-years (95% CI, 157–167/1000 person-years) within the first 12 months after hospital discharge. Bruising (949 bleeds [26%]) was the most common type of first bleeding event, followed by gastrointestinal bleed (705 bleeds [20%]), whereas intracranial bleed was relatively rare (81 bleeds [2%]). Significant predictors of postdischarge bleeding included history of bleeding complication, oral anticoagulant prescription, history of peripheral vascular disease, chronic obstructive pulmonary disease, and advanced age (>80 years). Predictors for postdischarge bleeding varied, depending on the anatomic site of the bleeding event. Conclusions: Bleeding complications after hospital discharge for acute coronary syndrome are common. Patients who experience these bleeding events have distinct baseline characteristics, which vary by anatomic site of the bleed. These characteristics can inform risk-benefit considerations in deciding on favorable combination and duration of secondary antithrombotic therapy.


This study was supported by the North Staffordshire Medical Institute 50th Anniversary Award (Grant No. B890).

Dr Edwards is an National Institute for Health Research Academic Clinical Lecturer.



Journal of the American Heart Association, 2019, Volume 8, Issue 21

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Department of Health Sciences


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Journal of the American Heart Association






Wiley Open Access



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