Temporal trends in antiplatelet/antithrombotic use in acute coronary syndromes and in-hospital major bleeding complications.
Antithrombotic and antiplatelet agents are essential for the management of patients with acute coronary syndromes (ACSs). These pharmacologic agents have the potential for increased risk of bleeding. It is not clear if the increased uptake of these therapies has resulted in a clinically evident increase in bleeding complications over time. In this study, we included 3,193 consecutive patients who were admitted to the University of Michigan with an ACS (unstable angina or myocardial infarction) between January 1999 and December 2004. These patients were analyzed for temporal trends in antithrombotic and antiplatelet agent use, thrombolytic therapy, cardiac catheterizations, percutaneous coronary interventions, and major bleeding complications (including gastrointestinal, vascular access, and intracranial hemorrhage). We found a decreasing temporal trend in the incidence of major in-hospital bleeding complications (p <0.001) despite an increasing use of ticlopidine/clopidogrel (p <0.0001), unfractionated heparin (p <0.01), glycoprotein IIb/IIIa inhibitors (p <0.0001), and percutaneous coronary intervention (p <0.0001) in the management of patients with ACSs. In conclusion, major bleeding remains a significant complication of ACS management but has decreased significantly over time. We believe that this decreasing bleeding trend may be because of better identification of higher risk patients, attention to correct dosing, appropriate monitoring, and incorporation of various periprocedural strategies in routine clinical practice.
Motivala
Apurva A
AA
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Tamhane
Umesh
U
Saab
Fadi
F
Li
Jin
J
Rogers
Eva-Kline
EK
Froehlich
James
J
Moscucci
Mauro
M
Eagle
Kim A
KA
Gurm
Hitinder S
HS
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D000368:Aged; D000789:Angina, Unstable / Q000188:drug therapy; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000453:epidemiology*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine