Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction

Abstract

Major bleeding has been associated with an increased risk of ischemic events and death in patients with acute coronary syndromes. We examined the relationship between bleeding and outcome in 1,389 consecutive patients with ST-elevation myocardial infarction (STEMI) presenting to a tertiary center between May 1, 2003 and July 10, 2007. We recorded bleeding, length of stay and death during the first 30 days after hospitalization. Major bleeding occurred in 10.9% (152/1389, 95% confidence interval [CI] 9.3-12.6%). In hospital mortality was significantly higher in patients with major bleeding compared to those without major bleeding (19.7 vs. 8.2%, odds ratio [OR] 2.8, 95% CI 1.8-4.3) and was evident in the subgroups of patients with a low TIMI STEMI risk score (7.9 vs. 1.8%, OR 4.6, 95% CI 1.2-17.0) and medium risk score (11.7 vs. 6.3%, OR 2.0, 95% CI 0.6-6.2) but not those with a high TIMI STEMI risk score (28.8 vs. 26.1%, OR 1.2, 95% CI 0.7-2.0) (P for interaction = 0.024). Our data indicate that serious bleeding is common in patients with STEMI treated with thrombolysis or PCI and is a powerful predictor of death, particularly in patients with a low TIMI risk score. Therapies that maintain efficacy while reducing bleeding and that reduce the risk of death in patients who develop bleeding are needed.

Corn trypsin inhibitor coating attenuates the prothrombotic properties of catheters in vitro and in vivo

“…Although heparin abrogates catheter thrombosis, its use in conjunction with potent antiplatelet drugs can lead to serious bleeding complications [3]. This is problematic because there is mounting evidence that bleeding in ACS patients is associated with adverse outcomes, including increased mortality [4][5][6][7]. To reduce the risk of bleeding, attention has focused on anticoagulants that are safer than heparin in the ACS setting.…”

Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

“…Given the known relationship of bleeding complications with prognosis [84, 88], we must be aware of this fact, since some associations recommended by guidelines [5–7] were systematically tested only in separate [23, 39, 45, 56]. Considering that part of the cumulative benefit over mortality may be related to the advent of PA (as pointed out by the the regression model), in the arms that used thombolytics—agents with potential bleeding effect—there, may be a trend to nullify the net benefit.…”

The clinical impact of bleeding during oral anticoagulant therapy

“…Third, we acknowledge that our study is at best, hypothesis-generating, as its application to clinical practice is limited. However, the perception that bleeding is a self-limiting, treatable and, overall, benign event should be reconsidered in light of accumulating evidence that anticoagulant-associated bleeding confers considerable morbidity and mortality that may override the clinical consequences of thromboembolic outcomes [22,23].…”