Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.
OBJECTIVE
Bleeding in patients with coronary artery disease has been linked with adverse outcomes. We examined the incidence and outcomes after bleeding in 20 078 patients with acute coronary syndromes (ACS) enrolled in the OASIS-5 trial who were treated with fondaparinux or the low-molecular weight heparin, enoxaparin.


RESULTS
Nine hundred and ninety (4.9%) patients developed major bleeding and 423 (2.1%) developed minor bleeding. Fondaparinux compared with enoxaparin reduced fatal bleeding [0.07 vs. 0.22%, relative risk (RR) 0.30, 95% CI: 0.13-0.71], non-fatal major bleeding (2.2 vs. 4.2%, RR 0.52, 95% CI: 0.44-0.61), minor bleeding (1.1 vs. 3.2%, RR 0.34, 95% CI: 0.27-0.42), and need for transfusion (1.8 vs. 3.1%, RR 0.56, 95% CI: 0.47-0.61) during the first 9 days. One of every six deaths during the first 30 days occurred in patients who experienced bleeding. Cox proportional hazards model revealed that major bleeding was associated with about a four-fold increased hazard of death, myocardial infarction, or stroke during the first 30 days and about a three-fold increased hazard during 180 days of follow up.


CONCLUSIONS
Bleeding in patients with ACS is a powerful determinant of fatal and non-fatal outcomes. Reducing the risk of bleeding using a safer anticoagulant strategy during the first 9 days is associated with substantial reductions in morbidity and mortality.
Budaj
Andrzej
A
Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
Eikelboom
John W
JW
Mehta
Shamir R
SR
Afzal
Rizwan
R
Chrolavicius
Susan
S
Bassand
Jean-Pierre
JP
Fox
Keith A A
KA
Wallentin
Lars
L
Peters
Ron J G
RJ
Granger
Christopher B
CB
Joyner
Campbell D
CD
Yusuf
Salim
S
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D000077425:Fondaparinux; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D009204:Myocardial Revascularization / Q000009:adverse effects; D011134:Polysaccharides / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux