{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:58:50Z","timestamp":1791644330795,"version":"4.3.4"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,4,5]]},"abstract":"\n Background<\/jats:title>\n \n Growth differentiation factor\u201015 (\n GDF<\/jats:styled-content>\n \u201015) is related to major bleeding when measured at initial presentation in patients with acute coronary syndromes (\n ACSs<\/jats:styled-content>\n ) treated with dual antiplatelet therapy. It is unknown whether follow\u2010up measurements provide additional information. The objective of this study was to investigate whether\n GDF<\/jats:styled-content>\n \u201015 measured 1\u00a0month after an\n ACS<\/jats:styled-content>\n provides additional information beyond the baseline levels with regard to the risk of major bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n GDF<\/jats:styled-content>\n \u201015 was measured at baseline and at 1\u00a0month after an\n ACS<\/jats:styled-content>\n in 4049 patients included in the PLATelet inhibition and patient Outcomes (PLATO) trial. The association between 1\u2010month\n GDF<\/jats:styled-content>\n \u201015 level and non\u2013coronary artery bypass grafting surgery\u2010related major bleeding was assessed by a multivariable Cox model, adjusting for baseline\n GDF<\/jats:styled-content>\n \u201015, age, anemia, impaired renal function, history of gastrointestinal bleeding, and sex. Elevated\n GDF<\/jats:styled-content>\n \u201015 (>1800\u00a0ng\/L) at 1\u00a0month was associated with an increased risk of non\u2010coronary artery bypass grafting\u2010related major bleeding (3.9% versus 1.2%; hazard ratio, 3.38; 95%\n CI<\/jats:styled-content>\n , 1.89\u20136.06), independent of baseline\n GDF<\/jats:styled-content>\n \u201015. Patients who had elevated\n GDF<\/jats:styled-content>\n \u201015 levels at baseline and subsequent nonelevated\n GDF<\/jats:styled-content>\n \u201015 at 1\u00a0month had a similar risk as patients who had nonelevated levels at both measurements.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n GDF<\/jats:styled-content>\n \u201015 at 1\u00a0month after an\n ACS<\/jats:styled-content>\n is related to the risk of bleeding during\n DAPT<\/jats:styled-content>\n and provides additional information on the bleeding risk beyond baseline\n GDF<\/jats:styled-content>\n \u201015 levels.\n GDF<\/jats:styled-content>\n \u201015 levels may therefore be useful as part of decision support concerning long\u2010term antithrombotic treatment in patients post\u2010\n ACS<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00391872.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.005580","type":"journal-article","created":{"date-parts":[[2017,4,14]],"date-time":"2017-04-14T20:20:10Z","timestamp":1492201210000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Growth Differentiation Factor 15 at 1\u00a0Month After an Acute Coronary Syndrome Is Associated With Increased Risk of Major Bleeding"],"prefix":"10.1161","volume":"6","author":[{"given":"Daniel","family":"Lindholm","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Hagstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan K.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C.","family":"Becker","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Health and Disease, Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Himmelmann","sequence":"additional","affiliation":[{"name":"AstraZeneca Research and Development, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo A.","family":"Katus","sequence":"additional","affiliation":[{"name":"Medizinische Klinik, Universit\u00e4tsklinikum Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Maurer","sequence":"additional","affiliation":[{"name":"Medical University of Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luis","family":"L\u00f3pez\u2010Send\u00f3n","sequence":"additional","affiliation":[{"name":"Hospital Universitario La Paz, IdiPaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe Gabriel","family":"Steg","sequence":"additional","affiliation":[{"name":"D\u00e9partement Hospitalo\u2010Universitaire FIRE, AP\u2010HP, H\u00f4pital Bichat, Paris, France"},{"name":"Paris Diderot University, Sorbonne Paris Cit\u00e9, Paris, France"},{"name":"NHLI Imperial College, ICMS, Royal Brompton Hospital, London, United Kingdom"},{"name":"FACT (French Alliance for Cardiovascular Trials), an F\u2010CRIN network, INSERM U1148, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"Storey","sequence":"additional","affiliation":[{"name":"Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agneta","family":"Siegbahn","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Clinical Chemistry and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Wallentin","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904327"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706482"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)05701-4"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409312"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500857"},{"key":"e_1_3_5_7_2","first-page":"390","article-title":"Long\u2010term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta\u2010analysis of randomized trials","volume":"37","author":"Udell JA","year":"2016","unstructured":"Udell JA, Bonaca MP, Collet J\u2010P, Lincoff AM, Kereiakes DJ, Costa F, Lee CW, Mauri L, Valgimigli M, Park S\u2010J, Montalescot G, Sabatine MS, Braunwald E, Bhatt DL. 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