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.