Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non–ST-Segment Elevation Acute Coronary Syndromes

Abstract

Patients with NSTE ACS treated in the community often receive excess doses of antithrombotic therapy. Dosing errors occur more often in vulnerable populations and predict an increased risk of major bleeding.

Association of Parenteral Anticoagulation Therapy With Outcomes in Non–ST‐Segment Elevation Acute Coronary Syndrome Patients Without Invasive Therapy: Findings from the Improving Care for Cardiovascular Disease in China (CCC) project

“…Importantly, in our previous study, we also found an increase in bleeding risk in patients receiving both PACT and PCI 5 . These previous results were consistent with the evidence proving that bleeding was dose‐dependent with PACT 19 …”

A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units

“…Increased age is associated with an increased risk of drug-related adverse events, such as bleeding, frequently caused by excess dosing of antithrombolytic drugs. 24 At variance with previous reports showing a high risk of major bleeding in elderly patients treated invasively (eg, 17% of patients ≥75 years of age in the invasive arm of the TACTICS TIMI-18 trial), 14 15 the cumulative rate of major bleeding remained consistently low over time (approximately 2% at 1 month) in the Italian registries reported in this study, and consistently with the results of the recent Italian Elderly ACS study. 7 This finding is most likely attributable to the moderate use of glycoprotein IIb/IIIa inhibitors, with a selective and decreasing use of low-molecular-weight heparin and with increasing use of the radial approach to PCI that accounts for approximately 35% in recent registries and as high as 70% in high-volume centres.…”

Correlates of Bleeding Events Among Moderate- to High-Risk Patients Undergoing Percutaneous Coronary Intervention and Treated With Eptifibatide

“…These findings parallel those observed in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) registry, in which the risk of bleeding requiring transfusion was substantially increased among patients who were more likely to be administered excessive rather than appropriately reduced doses of GPIIb/IIIa inhibitors, including elderly patients and those with renal insufficiency (14).…”