ACS major bleeding complications show decline
MedWire News: Analysis of the Global Registry of Acute Coronary Events reveals that rates of major bleeding in patients with acute coronary syndrome (ACS) declined over recent years, despite increasing use of intensive interventional and pharmacologic therapies.
“Although it may have been expected that the frequency of major bleeding would have increased over time on account of more potent antithrombotic therapies and antithrombotic combinations… and greater use of cardiac catheterization and percutaneous coronary intervention, in fact the converse was found,” report Keith Fox (University of Edinburgh, UK) and colleagues in the European Heart Journal.
They suggest that other changes in practice, such as improved instrumentation for cardiac catheterization, increasing use of radial access, more accurate parenteral antithrombotic dosing, less use of glycoprotein (GP) IIb/IIIa inhibitors, and changes in transfusion thresholds, have contributed to the reduction in bleeding frequency.
The researchers studied patients enrolled in the registry between 2000 and 2007. Of the 50,947 patients, 1160 (2.3%) had a major bleeding event, 513 (44.0%) of whom presented with ST-segment elevation ACS.
Despite significant increases in use of low-molecular-weight heparin, a thienopyridine within 24 hours of presentation, and percutaneous coronary intervention (particularly in ST-segment elevation ACS; all p<0.0001), the frequency of major bleeding for all ACS patients decreased from 2.6% to 1.8% (p<0.0001) over the study period.
After adjusting for patient characteristics, medications, and interventions, the downward temporal trend in bleeding remained, with a 6% lower risk each year.
Further analysis revealed that hospital characteristics were strongly associated with major bleeding, with a 10-fold higher rate for hospitals in the highest versus lowest quintile of median major bleed rate (4.1% vs 0.4%). Indeed, individual hospitals remained an independent predictor of bleeding even after adjusting for patient characteristics, treatments, and interventions (p<0.0001).
“These findings suggest that hospital-dependent variables may have an important impact upon the risk of major bleeding,” comment Fox and team.
“Individual hospital variables are likely to be the consequence of differences in practice patterns, and potentially amenable to change.”
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By Caroline Price