Impact of Major Bleeding on 30-Day Mortality and Clinical Outcomes in Patients With Acute Coronary Syndromes

Abstract

Major bleeding is a powerful independent predictor of 30-day mortality in patients with ACS managed invasively. Several factors independently predict major bleeding, including treatment with heparin plus GPI compared with bivalirudin monotherapy. Knowledge of these findings might be useful to reduce bleeding risk and improve outcomes in ACS.

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

“…While the tendency might be to discount this outcome, both minor and major bleeds have been associated with poor prognosis. 38,39 The increased frequency of minor bleeding that was observed with small molecule GPIs could be related to the longer infusion duration of these agents, in contrast to abciximab. For elective PCI, an abbreviated infusion of GPIs has been shown to be noninferior at preventing periprocedural myonecrosis while significantly reducing the risk of major bleeding.…”

Bleeding Complications in Acute Coronary Syndromes and Percutaneous Coronary Intervention: Predictors, Prognostic Significance, and Paradigms for Reducing Risk

“…7,9 A growing body of data reveals that bleeding complications in ACS and PCI (i) continue to occur with relative frequency; (ii) often exceed the frequency of ischemic complications such as MI; (iii) independently predict adverse outcomes, including death; and (iv) can be reduced using effective and safe antithrombotic regimens. Furthermore, since recent data imply that patients without bleeding complications have superior outcomes, including survival, antithrombotic therapy should be carefully selected to minimize the risk of both ischemic events and bleeding complications.…”

Issues in Management of Acute Coronary Syndromes: Effects of Bleeding

“…This relationship is independent of baseline patient characteristics, comorbid conditions, and treatments and also reflects a direct correlation between the severity of bleeding and the risk of the adverse outcome. 4,5,10,11 The adjusted risk of the 30-day mortality, for example, was five times higher in ACS patients with major bleeding compared with those with no bleeding in a recent meta-analysis. 4 Major bleeding was also strongly correlated with the risk for MI or stroke within 30 days in this analysis.…”

“…1 -3 However, the more widespread use of these modalities has also prompted an increase in the risk of bleeding-the presence and severity of which are major prognostic indicators in patients with ACS and in patients undergoing PCI. 4,5 To achieve optimal short-and long-term outcomes in patients with ACS, the ability to minimize the risk of ischemic events must be balanced against the increased risk of hemorrhagic events. This supplement reflects the findings of a recent roundtable discussion of experts focusing on the prevention, effects, and management of bleeding events among patients with ACS and those undergoing PCI.…”

“…4 For patients undergoing PCI, in addition to advanced age and renal insufficiency, independent baseline predictors of major bleeding includes female gender, hypertension, anemia, baseline ST-segment deviation, and baseline cardiac biomarker elevation. 5 The choice and dosage of antithrombotic therapy represent an important, modifiable risk factor for bleeding in ACS and PCI patients. Unfractionated heparin (UFH), for example, has poor bioavailability, carries the risk of thrombocytopenia, and produces wide interpatient variations in anticoagulant effects.…”