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Title: Managing Risk of Bleeding in Patients Prior to Antithrombotic Treatment Improves Outcomes
URL: http://www.pslgroup.com/dg/22AD76.htm
Doctor's Guide
September 4, 2008

SOPHIA ANTIPOLIS, France -- September 4, 2008 -- The appropriate management of acute coronary syndrome (ACS) has been shown over the last few decades to result in a significant improvement in outcome. However, the combined use of anticoagulants, antiplatelet agents, beta-blockers, and particularly antithrombotics may result in an excess of bleeding.

Jean-Pierre Bassand, Department of Cardiology, Pôle Coeur Poumons, University Hospital Jean-Minjoz, Besançon Cedex, France, presented a study at the European Society of Cardiology 2008 Congress (ESC) on managing ACS and minimising the risk of bleeding.

Until the recent past, bleeding was not considered to be a serious complication, but over the last 5 years, bleeding complications have in fact emerged as a major contributor to overall risk, with a significant increase in the rate of death, myocardial infarction (MI), and stroke in patients who suffer bleeding complications during the initial phase of ACS compared with those who do not.

In addition, blood transfusions have been shown to result in a higher risk of death and are suspected to have deleterious effects in selected groups of patients.

The risk factors for bleeding have been well identified. Older age, female sex, and low body weight have been identified as markers of the risk of bleeding. A past history of bleeding, the presence of renal failure, the use of an early invasive approach, excess doses of antithrombotic agents, and the use of glycoprotein IIb/IIIa inhibitors have also been identified as strong predictors of the risk of bleeding.

Conversely, careful selection of drugs, giving precedence to drugs with less potential for bleeding, the use of a radial versus femoral approach for invasive strategy, and systematic use of proton pump inhibitors to avoid gastrointestinal bleeding during the initial phase are all measures that have the potential to reduce bleeding risk.

In this context, some anticoagulants such as fondaparinux and bivalirudin have been shown to carry a lower risk of bleeding compared with low molecular weight heparins or unfractionated heparin. It would also appear that more consistent inhibition of platelet aggregation leads to better clinical outcomes, although with an increased risk of bleeding.

Overall, bleeding and possible blood transfusions have emerged as major contributors to worse outcomes in patients with ACS. Proper management of patients, with appropriate selection of doses, drugs, and arterial approach, combined with systematic evaluation of the bleeding risk prior to starting therapy may help prevent bleeding and improve patient outcomes.

SOURCE: European Society of Cardiology

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