Bleeding risk in patients with diabetes following PCI

This study looked at the risk of bleeding in patients with diabetes following a coronary intervention and treatment with dual anti-platelet therapy (DAPT). The authors concluded that patients with diabetes had a lower risk of bleeding while receiving DAPT compared to patients without diabetes.

Coronary artery disease develops when blood vessels are narrowed and the blood flow to the heart restricted. This is caused by a build-up of plaque on the walls of blood vessels. Percutaneous coronary intervention (PCI – also known as angioplasty) is a procedure used to widen the blood vessels. Stents are a common type of PCI. This involves a small inflatable balloon being placed and inflated inside a blood vessel to compress the plaque against the wall. Then a metal mesh tube (stent) is inserted to hold the plaques in place. Some stents can gradually release medication to prevent the plaque from forming again.

PCI patients must also take dual anti-platelet treatment (DAPT) to thin the blood and prevent blockage of the stent. While DAPT is necessary, it can lead to increased bleeding events after the procedure. Patients with diabetes are at a higher risk of blood vessels narrowing and so are in greater need of DAPT following PCI. The bleeding risk of patients with diabetes has not been fully studied.

This study included 2,946 patients who had undergone PCI and were treated with DAPT for 1 year. Self-reported bleeding was recorded at 1 month as well as at 6 and 12 months for all patients and compared in those with and without diabetes. Severity of bleeding was graded from 1 to 5, with 5 being the most severe. 

32.7% of patients had diabetes. Patients with diabetes were more likely to be female, non-White, have a higher body mass index (measure of body fat that takes height and weight into account), and have chronic kidney disease. 

78% of patients with diabetes reported bleeding events at grade 1 or higher during the overall study period. This was significantly lower compared to 87% of patients without diabetes. The number of patients reporting bleeding events of grade 2 or higher was similar in patients with and without diabetes. 

At the 1 month follow-up, patients with diabetes were 34% less likely to experience grade 1 or higher bleeding events than patients without diabetes. Patients with diabetes were 36% less likely to experience grade 1 or higher bleeding during the total follow-up compared to patients without diabetes. 

The number of patients who discontinued DAPT during the one year follow up was similar between diabetic patients and non-diabetic patients.

The authors concluded that patients with diabetes who have undergone PCI and are treated with DAPT are less likely to experience bleeding over the course of 1 year than patients without diabetes. .

Bleeding events were self-reported for this study and may have been under- or over-reported.

Consult with your physician if you have concerns regarding bleeding after a PCI procedure.