Article Text

Original research
Patient perspectives of nuisance bleeding and adherence to dual antiplatelet therapy: a qualitative study
  1. Christalla Pithara1,2,
  2. Maria Pufulete3,
  3. Thomas W. Johnson4 and
  4. Sabi Redwood1,2
  1. 1National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
  2. 2Population Health Sciences, University of Bristol, Bristol, UK
  3. 3Bristol Trials Centre (Clinical Trials and Evaluation Unit), University of Bristol, Bristol, UK
  4. 4Department of Cardiology, Bristol Heart Institute, Bristol, UK
  1. Correspondence to Dr Christalla Pithara; christalla.pithara{at}


Objective To understand the experiences of patients with dual antiplatelet therapy (DAPT) and nuisance bleeding, and their perspectives of the impact of nuisance bleeding on medication adherence and information seeking.

Methods We conducted focus groups with patients who had undergone percutaneous coronary intervention, coronary artery bypass graft and conservatively managed acute coronary syndrome patients. Two focus groups were with patients at the early stages of treatment (0–3 months), and two with patients coming to the end of treatment (9–12 months). Group discussions were audio recorded, and recordings were transcribed verbatim, anonymised and analysed using framework analysis.

Findings Nine patients taking DAPT for up to 3 months, and 12 taking DAPT between 9 and 12 months participated in the focus groups. We found that: (1) participants adhered to treatment when they believed DAPT was important to health outcomes; (2) those who experienced nuisance bleeding reported symptoms to be mild and manageable; (3) participants’ and their family’s understanding of DAPT risks and benefits, and their ability to manage symptoms, influenced perspectives of and experiences with adherence. Factors influencing DAPT knowledge included access to medication counselling, engaging with information communicated during medication counselling, and access to timely, relevant and expert information and advice after discharge from hospital.

Conclusions Positive attitudes towards adherence were facilitated by knowledge and understanding of DAPT and confidence in dealing with symptoms caused by DAPT, but hindered by lack of opportunities to access relevant, timely and appropriate medication counselling. Education interventions should aim to support medication literacy through family-centred approaches and involve patients and families at all stages of intervention design and evaluation.

  • antiplatelet treatment
  • quality of care and outcomes
  • education
  • delivery of care

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  • Contributors CP was responsible for data collection, data analysis and drafted the manuscript. MP conceived the ADAPTT study, organised patient recruitment and revised the manuscript for intellectual content. TWJ organised patient recruitment, provided clinical cardiology input and revised the manuscript for intellectual content. SR designed the qualitative study, provided intellectual input during the analysis of data and drafting of the manuscript, and approved the final manuscript. All authors have read and approved the final manuscript.

  • Funding This research was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration West (NIHR ARC West). This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA 14/192/89). The British Heart Foundation and NIHR Bristol Biomedical Research Unit for Cardiovascular Disease funded some staff time (MP).

  • Disclaimer The views expressed in this article are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

  • Competing interests TWJ has received honoraria or consultation fees from Abbott, Bayer AG, Biosensors, Boston Scientific, Medtronic, Terumo and Vascular Perspectives; received grants/research support from AstraZeneca and Bayer; and participates in a company sponsored speaker’s bureau for Abbott. All other authors have no competing interests to declare.

  • Patient consent for publication Not required.

  • Ethics approval The study was carried out according to the principles of the Declaration of Helsinki, and was approved by the NHS Research Ethics Committee and the Health Research Authority (IRAS number 203302).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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