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

Mehran, Roxana; Pocock, Stuart J.; Stone, Gregg W.; Clayton, Tim; Dangas, George; Feit, Frederick; Manoukian, Steven V.; Nikolsky, Eugenia; Lansky, Alexandra J.; Kirtane, Ajay J.; White, Harvey D.; Colombo, Antonio; Ware, James H.; Moses, Jeffrey W.; Ohman, E. Magnus

doi:10.1093/eurheartj/ehp110

Cited by 315 publications

(199 citation statements)

References 26 publications

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“…Most of the reports regarding the risk of combined therapy with DAPT comes from the studies on patients with acute coronary syndrome [3,[19][20][21][22]. It is known that bleeding complications are observed in 2-8% of patients with coronary artery disease and are more frequent in women, in elderly, in patients with renal dysfunction and those with a history of bleeding [3][4][5]. Many studies confirmed that the use of DAPT with oral anticoagulants efficiently reduces the risk of recurrent coronary incidents, but is related to worse prognosis due to increased risk of bleeding [19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Stępińska

Czerwińska²,

Witkowski

et al. 2013

Cardiol J.

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Section: Discussionmentioning

confidence: 99%

“…The risk of bleeding complications in population of patients undergoing TAVI is increased due to age of the patients and the presence of numerous concomitant diseases. Bleeding complications and blood transfusions worsen the early and long-term prognosis of patients after interventions [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Stępińska

Czerwińska²,

Witkowski

et al. 2013

Cardiol J.

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“…К настоящему времени общепризнано, что крупные кровотечения не только несут в себе непосредственную угрозу для жизни больных, но и могут существенно уве-личивать риск развития ишемических событий и риск смерти от этих событий [7][8][9]. Среди объяснений подоб-ного влияния кровотечений на риск ишемических осложнений: вызванная кровопотерей артериальная гипотония с гипоперфузией сердца и мозга, перелива-ние препаратов крови, вызывающее активацию системы гемостаза и, наконец, отмена антиагрегантов и антикоа-гулянтов с многократно возрастающей угрозой тромбо-за.…”

Section: значимость крупных кровотечений при оксunclassified

Anti-Thrombocytic Drugs for Acute Coronary Syndrome: Direct Comparison of Hemorrhagic Safety Thrombocyte P2y12-Receptor Blockers Ticagrelor and Clopidrogel (Based on Plato Study Results

Аверков¹

2016

Med. sov.

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КАРДИОЛОГИЯ РЕЗУЛЬТАТЫ ИССЛЕДОВАНИЯ PLATO [6] КАК ОСНОВАНИЕ ДЛЯ ПРЕДПОЧТИТЕЛЬНОГО ИСПОЛЬЗОВАНИЯ ТИКАГРЕЛОРА18 624 больных, госпитализированных с ОКС (с подъ-емами или без подъемов сегмента ST), используя двой-ной слепой метод и рандомизацию, были разделены на 2 группы. В одной из них применялось стандартное лече-ние, частью которого был клопидогрел (300 мг -нагру-зочная доза для большинства больных, затем 75 мг/сут), в другой вместо клопидогрела использовался тикагрелор (180 мг нагрузочная доза, затем 90 мг 2 р/сут). Длитель-ность сравнения около 12 месяцев. Основная конечная точка при оценке эффективности включала смерть от сердечно-сосудистых причин, инфаркт миокарда (ИМ) или инсульт. В итоге исследования суммарная частота этих событий составила 9,8% у получавших тикагрелор и 11,7% у получавших клопидогрел (отношение рисков, 0,84; 95% ДИ [0,77 до 0,92; p < 0,001]). Отмечена стати-стически значимая разница по частоте ИМ (5,8% в группе тикагрелора против 6,9% в группе клопидогрела, p = 0,005) и смерти от сердечно-сосудистых сосудистых причин (4,0% против 5,1%, p = 0,001). Наиболее весомой находкой исследования оказалась разница в частоте случаев смерти от всех причины (4,5%, в группе тикагре- O.V. AVERKOV, MD, Filatov Municipal Clinical Hospital No.15, Moscow ANTI-THROMBOCYTIC DRUGS FOR ACUTE CORONARY SYNDROME: DIRECT COMPARISON OF HEMORRHAGIC SAFETY THROMBOCYTE P2Y 12 -RECEPTOR BLOCKERS TICAGRELOR AND CLOPIDROGEL (BASED ON PLATO STUDY RESULTS)Double anti-platelet therapy (DAPT) comprising a combination of acetylsalicylic acid and one of the thrombocyte P2Y 12-receptor blockers is considered an obligatory element of the acute coronary syndrome (ACS) therapy [1-5]. Enlargement of the antiplatelet drugs range with active implementation of ticagrelor and prasugrel led to questions in cardiologists who render medical aid to acute coronary syndrome patients. Despite the priority use of these drugs declared in recommendations instead of clopidrogel doctors practically daily face a necessity to choose the optimal P2Y 12 blocking agent assessing the expected individual effectiveness, hemorrhagic safety and cost of the rather long-acting therapy. For doctors practicing in the territory of the RF as opposed to doctors in other countries the problem of the P2Y 12 blocking agent is less large-scale as they have to choose only between ticagrelor and clopidrogel (prasugrel is not applied in the RF).

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“…(31) The benefit is even greater in the population with high-risk NSTE ACS. (3) Early invasive management is also estimated to increase the risk of severe bleeding by 2.4%. (32) The most common site of bleeding is the actual puncture site, and complications range from hematoma and arteriovenous fistula to pseudoaneurysm and retroperitoneal bleeding.…”

Section: Benefits and Risks Of Nste Acs Treatmentmentioning

confidence: 99%

“…(1) Furthermore, severe bleeding increases the risk of acute myocardial infarction (AMI), (1) stroke (1) and the need for urgent myocardial revascularization. (3) Therefore, bleeding has become the new challenge in managing NSTE ACS and has inspired the publication of two consensus statements. (4,5) However, neither of them provides much guidance on the management of complications and the risk-benefit ratio of using various antiplatelet and antithrombotic agents.…”

Section: Introductionmentioning

confidence: 99%

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

Moraes¹,

Chammas²,

Neto³

et al. 2012

Rev. bras. ter. intensiva

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The development of antiplatelet and antithrombotic therapies, in addition to interventionist strategy, has resulted in great improvements in the outcomes of patients with non-ST-segment elevation acute coronary syndrome. Parallel to therapeutic advances, bleeding, which can be induced during management, increases the risk of recurrent ischemia, myocardial infarction and death. The present literature review describes the benefits and bleeding risks of each medication or intervention strategy and suggests guidelines for managing these patients. arteries) scores are prominent. The TIMI score was the first to be developed and is widely used; however, it has low sensitivity, given that hemoglobin needs to be reduced by 5 g/dL for bleeding to be considered severe. The GUSTO score has a higher sensitivity and better correlation with death and reinfarction at 30 days and at 6 months compared to TIMI.(8) The variety of scores (Table 1) has complicated comparisons between studies.With the purpose of standardizing the definitions of bleeding, North American institutions have recently created the Bleeding Academic Research Consortium (BARC).(9) This score stratifies bleeding on a scale from 0 (no bleeding) to 5 (fatal bleeding) and, as a major advantage, provides the ability to assess patients subjected to myocardial revascularization surgery (MRS).(9) Because BARC's definitions of bleeding have been achieved by consensus, it still requires validation, and new studies on ACS are encouraged to use this score together with previous scores so that such validation may be achieved in the near future.(9) For now, comparisons between studies of bleeding outcomes demand caution. BENEFITS AND RISKS OF NSTE ACS TREATMENTKnowledge of the risk-benefit ratio of the various tools used in the treatment of ACS is essential for the individualization of therapy (Table 2).Acetylsalicylic acid (ASA) was one of the first medications assessed for the treatment of NSTE ACS and was established as a proven method after demonstrating a 56% reduction in cardiovascular death.(10) The antiplatelet effect of ASA is irreversible and results from its inhibition of thromboxane A2. In the long run, smaller daily doses of 75 to 100 mg provide the same benefit as do larger doses of 200 mg and reduce the incidence of major bleeding by 1.8%, according to the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) criteria.(11) The gastrointestinal tract is the most common site of bleeding caused by ASA, and its chronic use increases absolute risk by 0.12% a year.(12) Acetylsalicylic acid increases the risk of intracranial bleeding 1.65-fold for an increase in absolute annual risk of 0.03%.(12) Given the great benefit on mortality provided by ASA in treatment and secondary prevention, the risk of bleeding hardly justifies its nonprescription. Therefore, ASA is contraindicated only in cases of known hypersensitivity, active peptic ulcers, blood dyscrasias or severe liver disease. (13) Clopidogrel, a thienopyridine, is an alternative for patient...

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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

Cited by 315 publications

References 26 publications

Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Anti-Thrombocytic Drugs for Acute Coronary Syndrome: Direct Comparison of Hemorrhagic Safety Thrombocyte P2y12-Receptor Blockers Ticagrelor and Clopidrogel (Based on Plato Study Results

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

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