Abstract: Objective To investigate the effects of hypoalbuminemia and age on hemorrhagic events in patients taking atorvastatin, clopidogrel and aspirin simultaneously. Methods Patients with cardiovascular disease who underwent stenting for coronary artery stenosis and were treated with atorvastatin 20 mg, clopidogrel 75 mg, and aspirin 100 mg between January 2016 and May 2018 were selected as the subjects. To determine the effect of protein content, these patients were divided into two groups: the low albumin (≤35 g/L) group and normal albumin (> 35 g/L) group. The number of cases of urinary occult blood, fecal occult blood and hemoglobin was compared between the two groups and the difference was analyzed. When the influence of age was studied, the patients were divided again into two groups: those who were ≥70 years old and those who were under 70. Chi-square test was used to compare categorical variables. Bleeding was a dependent variable,while age, sex, systolic blood pressure upon admission, heart rate, hematocrit, endogenous creatinine clearance rate, serum albumin content, diabetes mellitus, peripheral vascular and cerebrovascular diseases were independent variables. Binomial logistic regression analysis was used to assess the risk of bleeding caused by hypoproteinemia or otherwise. Results There were significant differences in the number of cases in which urinary occult blood turned positive between the low albumin group and normal albumin group. There was also difference in the number of cases in which fecal occult blood turned positive after medication. Levels of hemoglobin declined more drastically after medication. There were significant differences in the number of cases in which levels of hemoglobin declined by over 10 g/L and were below normal values. There was significant difference in the number of cases in which urinary occult blood turned positive after medication between those ≥ 70 years old and those < 70 years old. Fecal occult blood turned positive after medication in more cases in the elderly group than in the younger group, but there was no significant difference. Multivariate logistic regression analysis showed that age, femininity and low albumin increased the risk of bleeding in these patients. Conclusion In patients who take atorvastatin, clopidogrel, and aspirin at the same time, low albumin and advanced age can increase the chance of bleeding.

Key words: hypoalbuminemia, advanced age, hemorrhage, atorvastatin, clopidogrel, aspirin