Bleeding events in patients receiving enoxaparin for the management of non-ST-elevation acute coronary syndrome (NSTEACS) at Dunedin Public Hospital, New Zealand.
OBJECTIVE
To determine the incidence of bleeding associated with the use of enoxaparin in NSTEACS at Dunedin Public Hospital (DPH) and to identify bleeding risk factors in this patient group.


METHODS
A case-control retrospective review of clinical notes was undertaken. NSTEACS admissions in 2005 where a bleeding event occurred were identified and matched with controls (matched for age and sex). The incidence of Thrombolysis in Myocardial Infarction (TIMI) minor and major bleeding, not related to cardiac surgery, was determined. Univariate and multivariate analyses were used to identify risk factors for all bleeding events.


RESULTS
There were 446 eligible NSTEACS admissions (409 patients), of which 47 bleeding events (10.5%) were reported. Eight events (1.8%) were major according to the TIMI bleeding classification. Three risk factors were identified: renal function, the duration of enoxaparin therapy, and medical conditions involving haemostasis. Renal impairment and the duration of enoxaparin therapy were found to be significant predictors of bleeding (p=0.036 and p=0.008, respectively).


CONCLUSIONS
The incidence of bleeding in NSTEACS patients treated with enoxaparin at DPH is comparable to that reported in the literature. Renal impairment and prolonged treatment with enoxaparin were significantly associated with an increase in bleeding risk.
Al-Sallami
Hesham
H
School of Pharmacy, University of Otago, PO Box 913, Dunedin, New Zealand. hesham.al-sallami@stonebow.otago.ac.nz
Ferguson
Ruth
R
Wilkins
Gerard
G
Gray
Andrew
A
Medlicott
Natalie J
NJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D017984:Enoxaparin / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000145:classification / Q000209:etiology; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D012307:Risk Factors
D000925:Anticoagulants; D017984:Enoxaparin