Avoiding and managing bleeding complications in patients with non-ST-segment elevation acute coronary syndromes.
Antithrombotic therapy coupled with early use of cardiac catheterization and revascularization have decreased morbidity and mortality rates in patients who have acute ischemic heart disease but who carry a risk for bleeding. Bleeding complications in patients with acute coronary syndromes are associated with worse clinical outcomes, including recurrent ischemic events and death. Determining the appropriate balance between preventing ischemic events and causing bleeding in patients with acute coronary syndromes present a challenging problem for clinicians. Antithrombotics studied in recent clinical trials that have focused on bleeding reduction include bivalirudin and fondaparinux. In this review, the incidence, predictors, and clinical outcomes associated with bleeding are discussed. Furthermore, the association between antithrombotic agents and bleeding and propose strategies to prevent bleeding complications are also discussed.
Department of Cardiology, Medical School, University of Ioannina, Greece.
Thomas Z
TZ
Potsis
Christos
C
Katsouras
John A
JA
Goudevenos
D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005170:Factor X / Q000037:antagonists & inhibitors; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000077425:Fondaparinux; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D011134:Polysaccharides / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011134:Polysaccharides; D005170:Factor X; D000077425:Fondaparinux