Among those taking Plavix and aspirin, about 60 percent of the visits were for nosebleeds or other minor bleeds. The rate of emergency department visits was 1.2 for every 1,000 prescriptions for dual antiplatelet therapy, compared with 2.5 for every 1,000 prescriptions for warfarin, the researchers found.
"There is an inclination in the clinical community to treat the hemorrhagic risk of dual antiplatelet therapy a little bit less seriously than [the risk for] warfarin," Shehab said. "We hope by shedding some light on the burden and the nature of the bleeding risks of dual antiplatelet therapy that providers will take the risk seriously," she added.
Moreover, doctors should inform their patients of the risks for small bleeds associated with dual antiplatelet therapy, she noted.
Shehab cautioned that this study is not designed to recommend one therapy over another, but only to assess the problem of bleeding for dual antiplatelet therapy.
Dr. Gregg Fonarow, American Heart Association spokesman and professor of cardiology at the University of California, Los Angeles, said that "the use of dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the risk of cardiovascular events in patients after acute coronary syndromes and patients undergoing coronary stenting."
There is a well-defined increased risk of major and minor bleeding with dual antiplatelet therapy, but in most patients the benefits of therapy outweigh these risks, he said.
"These findings reinforce the need for patients receiving dual antiplatelet therapy to be well-educated on the benefits of treatment and the importance of adherence, but also the increased risk of major and minor bleeding," Fonarow said.
For more information on antiplatelet therapy, visit the American He
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