LAUSR

Triple antithrombotic therapy (TAT) is known to increase bleeds and its relevance is questioned. No study has observed the long-term risk of bleeding and health care costs from a sex perspective, in a total TAT population. We investigated the rate of all bleeds in patients receiving TAT at index hospitalization and within one year. We explored early discontinuation of TAT and potential sex disparities. We also assessed health care costs related to bleeding complications. All patients discharged with TAT registered in SWEDEHEART in the County of Östergötland 2009–2015 were included. Information about bleeds during one-year follow-up were retrieved from the medical records. All bleeds receiving medical attention were included. Resource use associated with bleeds were assigned unit cost to estimate the health care costs associated with bleeding episodes. Among 272 identified patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p=0.01) and bled more (48.6 vs. 37.1%, p=0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively. The very high bleeding incidence in patients with TAT is a cause of concern, especially in women. There is a need for an adequately sized randomized, controlled trial to determine a safe but still effective treatment for these patients.