Background:The relationship between invasive vascular procedures and bleeding in patients with peripheral artery disease has not been well described in the literature. This post hoc analysis from the EUCLID trial (Examining Use of Ticagrelor in Peripheral Artery Disease) aimed to describe the incidence of major and minor postprocedural bleeding and characterize the timing and severity of bleeding events relative to the procedure.Methods:EUCLID was a multicenter, randomized controlled trial of 13 885 patients with symptomatic peripheral artery disease that tested the efficacy and safety of ticagrelor compared with clopidogrel for the prevention of major adverse cardiovascular events. A total of 2661 patients underwent 3062 coronary revascularization, peripheral revascularization, and amputation during the study. The primary safety end point was Thrombolysis in Myocardial Infarction major or minor bleeding. All bleeding events were formally adjudicated by a clinical end point classification group.Results:Major bleeding events most often occurred ≤7 days following the procedure. The incidence of Thrombolysis in Myocardial Infarction major or minor bleeding ≤7 days following peripheral revascularization (3.3%; 95% CI, 2.5%–4.1%) was similar to rates after coronary revascularization (4.0%; 95% CI, 2.6%–5.4%) and lower extremity amputation (2.3%; 95% CI, 0.8%–3.8%). The severity of bleeding events (as graded by drop in hemoglobin, need for transfusion, bleeding in a critical location, and fatal bleeding) was also similar following peripheral, coronary revascularization, and lower extremity amputation.Conclusions:The incidence of Thrombolysis in Myocardial Infarction major/minor bleeding following peripheral revascularization is comparable to rates after coronary revascularization and lower extremity amputation, and the majority of bleeding events occur within 7 days following the procedure. The severity of periprocedural bleeding is also similar after procedures, with the most frequently adjudicated reason being a drop in hemoglobin ≥2 g/dL. Future studies should be performed to enhance our understanding of bleeding risk related to revascularization and amputation procedures in peripheral artery disease patients.

中文翻译：

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程序性出血对周围动脉疾病的影响：EUCLID试验分析。

背景：在外周动脉疾病患者中，侵入性血管手术与出血之间的关系尚未在文献中得到很好的描述。这项来自EUCLID试验的事后分析（检查Ticagrelor在外周动脉疾病中的使用）旨在描述手术后大出血和小出血的发生率，并描述与手术相关的出血事件的发生时间和严重程度。方法：EUCLID是一个多中心研究，一项针对13 885例有症状的外周动脉疾病患者的随机对照试验，测试了替加格雷或氯吡格雷预防重大心血管不良事件的有效性和安全性。在研究期间，共有2661名患者进行了3062例冠状动脉血运重建，外周血运重建和截肢。主要安全终点是心肌梗塞大出血或小出血的溶栓治疗。结果：所有出血事件均由临床终点分类小组正式裁定。结果：主要出血事件最常在手术后≤7天发生。周围血运重建后≤7天的心肌梗塞大出血或轻度溶栓的发生率（3.3％； 95％CI，2.5％–4.1％）与冠状动脉血运重建后的发生率（4.0％； 95％CI，2.6％–5.4）相似％）和下​​肢截肢（2.3％; 95％CI，0.8％–3.8％）。在周围，冠状动脉血运重建和下肢截肢后，出血事件的严重程度（按血红蛋白下降，需要输血，关键部位出血和致命性出血分级）也相似。外周血运重建后心肌梗塞大/小出血的溶栓发生率与冠状动脉血运重建和下肢截肢后的发生率相当，并且大多数出血事件发生在手术后的7天内。手术后围手术期出血的严重程度也相似，最常见的判定原因是血红蛋白下降≥2g / dL。应该进行进一步的研究，以加深我们对周围动脉疾病患者血运重建和截肢手术相关的出血风险的了解。手术后围手术期出血的严重程度也相似，最常见的判定原因是血红蛋白下降≥2g / dL。应当进行进一步的研究，以加深我们对周围动脉疾病患者与血运重建和截肢手术相关的出血风险的了解。手术后围手术期出血的严重程度也相似，最常见的判定原因是血红蛋白下降≥2g / dL。应该进行进一步的研究，以加深我们对周围动脉疾病患者血运重建和截肢手术相关的出血风险的了解。