Vol. 45 | No. 2 | July-December 2017 Back

Open Access

Incidence and Clinical Profile of Bleeding Among Adult Acute Coronary Syndrome Patients Admitted in a Tertiary Hospital (BLEED-ACS)

Michael Anthony C. Estur, Felix Eduardo Punzalan, Paul Ferdinand Reganit, Elmer Jasper Llanes
Dec 2017 DOI 10.69944/pjc.7fc5859816

Abstract

Background: Current guidelines recommend the use of multiple antithrombotic drugs and aggressive invasive  strategies in the management of patients with acute coronary syndromes (ACS). However, these interventions could result in bleeding, both minor and life-threatening. This study aimed to determine the incidence of bleeding among adult patients admitted for ACS treated with antiplatelets, anticoagulants and/or thrombolytics.  

Methods: This was a prospective observational study of adult patients admitted in the medical intensive care  unit (ICU) for ACS and treated with antiplatelets, anticoagulants and/or thrombolytics from January 2016 to August 2016. The patients were observed for occurrence of any form of bleeding, and factors associated with bleeding were identified.  

Results: Fifty-eight patients were included in the study. The overall incidence of bleeding was 25.86%. Female  sex and prior history of vascular disease or cerebrovascular disease were independently associated with a higher risk of bleeding (RR of 2.45 and 3.1, respectively; p<0.05). There were no statistically significant differences in morbidity and mortality between those with and without bleeding. However, the number of days of ICU hospital stay among patients with bleeding occurrence was higher compared to those without bleeding (median: 6 vs 4 days). 

Conclusion: Bleeding is a common non-cardiac complication of current management for ACS and is associated  with prolonged hospital stay. Simple baseline demographic and clinical characteristics identify patients at increased risk of bleeding.

References
  1. Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J,  Montalescot G, White K, Goldberg RJ. Predictors of major bleeding  in acute coronary syndromes: the Global Registry of Acute Coronary  Events (GRACE). Eur Heart J. 2003;24:1815–1823. 
  2. Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S.  Adverse impact of bleeding on prognosis in patients with acute  coronary syndromes. Circulation. 2006;114:774-782. 
  3. Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK,  et al. Baseline risk of major bleeding in non-ST-segment-elevation  myocardial infarction: the CRUSADE (Can Rapid risk stratification  of Unstable angina patients Suppress ADverse outcomes with Early  implementation of the ACC/AHA Guidelines) Bleeding Score.  Circulation. 2009;119:1873–8. 
  4. Mehran R, Pocock SJ, Stone GW, Clayton TC, Dangas GD, Feit F,  et al. Associations of major bleeding and myocardial infarction with  the incidence and timing of mortality in patients presenting with  non-ST-elevation acute coronary syndromes: a risk model from the  ACUITY trial. Eur Heart J. 2009;30:1457–66. 
  5. Mehran R, Pocock SJ, Nikolsky E, Clayton T, Dangas GD, Kirtane  AJ, et al. A Risk Score to Predict Bleeding in Patients With Acute  Coronary Syndromes. J Am Coll Cardiol 2010;55:2556–66. 
  6. Steg, P., et.al. Bleeding in acute coronary syndromes and percutaneous  coronary interventions: position paper by the Working Group on  Thrombosis of the European Society of Cardiology. European Heart  Journal European Heart Journal (2011) 32, 1854–1864 doi:10.1093/eurheartj/ehr204 
  7. Erdem G, Flather M. Assessing bleeding risk in acute coronary  syndromes. Rev Esp Cardiol. 2012;65(1):4–6
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.