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

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. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.