Growth Differentiation Factor 15 at 1 Month After an Acute Coronary Syndrome Is Associated With Increased Risk of Major Bleeding.

Abstract

BACKGROUND:

Growth differentiation factor-15 (GDF-15) is related to major bleeding when measured at initial presentation in patients with acute coronary syndromes (ACSs) treated with dual antiplatelet therapy. It is unknown whether follow-up measurements provide additional information. The objective of this study was to investigate whether GDF-15 measured 1 month after an ACS provides additional information beyond the baseline levels with regard to the risk of major bleeding.

METHODS AND RESULTS:

GDF-15 was measured at baseline and at 1 month after an ACS in 4049 patients included in the PLATelet inhibition and patient Outcomes (PLATO) trial. The association between 1-month GDF-15 level and non-coronary artery bypass grafting surgery-related major bleeding was assessed by a multivariable Cox model, adjusting for baseline GDF-15, age, anemia, impaired renal function, history of gastrointestinal bleeding, and sex. Elevated GDF-15 (>1800 ng/L) at 1 month was associated with an increased risk of non-coronary artery bypass grafting-related major bleeding (3.9% versus 1.2%; hazard ratio, 3.38; 95% CI, 1.89-6.06), independent of baseline GDF-15. Patients who had elevated GDF-15 levels at baseline and subsequent nonelevated GDF-15 at 1 month had a similar risk as patients who had nonelevated levels at both measurements.

CONCLUSIONS:

GDF-15 at 1 month after an ACS is related to the risk of bleeding during DAPT and provides additional information on the bleeding risk beyond baseline GDF-15 levels. GDF-15 levels may therefore be useful as part of decision support concerning long-term antithrombotic treatment in patients post-ACS.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

• Authors: Daniel Lindholm, Emil Hagström, Stefan K James, Richard C Becker, Christopher P Cannon, Anders Himmelmann, Hugo A Katus, Gerald Maurer, José Luis López-Sendón, Philippe Gabriel Steg, Robert F Storey, Agneta Siegbahn, Lars Wallentin
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 6 Issue 4 (Apr 14 2017) ISSN: 2047-9980 [Electronic] England
• PMID: 28411246 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Biomarkers
• GDF15 protein, human
• Growth Differentiation Factor 15
• Platelet Aggregation Inhibitors
• Clopidogrel
• Ticagrelor
• Adenosine
• Ticlopidine
• Aspirin

Topics

• Acute Coronary Syndrome (blood, complications, diagnosis, drug therapy)
• Adenosine (adverse effects, analogs & derivatives)
• Aged
• Aspirin (adverse effects)
• Biomarkers (blood)
• Clopidogrel
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Growth Differentiation Factor 15 (blood)
• Hemorrhage (blood, chemically induced, diagnosis)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Platelet Aggregation Inhibitors (adverse effects)
• Predictive Value of Tests
• Proportional Hazards Models
• Risk Assessment
• Risk Factors
• Ticagrelor
• Ticlopidine (adverse effects, analogs & derivatives)
• Time Factors
• Treatment Outcome
• Up-Regulation