Increased long-term bleeding complications in females undergoing endovascular revascularization for peripheral arterial disease

Females with peripheral arterial disease (PAD) treated with endovascular interventions have increased limb-based procedural complications compared to males. Little is known regarding long-term bleeding risk in these patients who often require long-term antiplatelet or anticoagulation therapy. We hypothesize that females have a higher incidence of bleeding events compared to males in the year following endovascular intervention for PAD. Adults (≥65 years) who underwent endovascular revascularization for PAD between 2008-2015 in Medicare claims data were identified. Patients were allocated by prescribed post-procedural antithrombotic therapy including 1) antiplatelet therapy, 2) anticoagulation therapy, 3) dual antiplatelet and anticoagulation therapy, and 4) no prescription antithrombotic therapy. Bleeding events were classified as gastrointestinal, intracranial, hematoma, airway, or other. Crude and covariate-standardized 30-, 90- and 365 days cumulative incidence of bleeding events, overall and by sex, were estimated using Aalen-Johansen estimators accounting for death as a competing risk. Sex differences were identified using Gray’s test. Of 31,593 eligible patients, 54% were females. Females were older (77.9 vs 75.5 years) and tended to use antiplatelet therapy more often at 30-, 90- and 365 days post-intervention. Clopidogrel was the most prescribed antiplatelet, and 32% of patients continued its use at 365 days. Anticoagulants were prescribed to 26% of patients at the time of the procedure, and only 8.8% continued anticoagulation at 365 days. Thirty-one percent of patients were diagnosed with a bleeding event within 1-year after intervention. Cumulative incidence of any bleeding event during the post-intervention period was higher in females compared to males with a risk difference of 3% between sex cohorts (p