title: Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.
abstract: 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.
authors: Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
authors: Andrzej
authors: A
authors: Budaj
authors: John W
authors: JW
authors: Eikelboom
authors: Shamir R
authors: SR
authors: Mehta
authors: Rizwan
authors: R
authors: Afzal
authors: Susan
authors: S
authors: Chrolavicius
authors: Jean-Pierre
authors: JP
authors: Bassand
authors: Keith A A
authors: KA
authors: Fox
authors: Lars
authors: L
authors: Wallentin
authors: Ron J G
authors: RJ
authors: Peters
authors: Christopher B
authors: CB
authors: Granger
authors: Campbell D
authors: CD
authors: Joyner
authors: Salim
authors: S
authors: Yusuf
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D000077425:Fondaparinux