Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes.
OBJECTIVE
In patients with acute coronary syndromes (ACS), the negative impact of baseline haemoglobin levels on ischaemic events, particularly death, is well established, but the association with bleeding risk is less well studied. The aim of this study was to assess the impact of baseline haemoglobin levels on major bleeding complications.


RESULTS
Pooled analysis of OASIS 5 and 6 data involving 32 170 patients with ACS with and without ST-segment elevation was performed. The association between baseline haemoglobin and major bleeding or ischaemic events was examined using multiple regression model.


METHODS
were 30-day rates of major bleeding, death, and death/myocardial infarction (MI) analysed according to baseline haemoglobin levels. Baseline haemoglobin level independently predicted the risk of overall, procedure-related, and non-procedure-related major bleedings at 30 days [odds ratio (OR) 0.94, 95% CI 0.90-0.98; OR 0.94, 95% CI 0.90-0.99; and OR 0.89, 95% CI 0.83-0.95, respectively, per 1 g/dL haemoglobin increment above 10 g/dL]. In addition, a curvilinear relationship between baseline haemoglobin levels and death at 30 days was observed with a 6% decrease in the risk for every 1 g/dL haemoglobin increment above 10 g/dL up to 15.9 g/dL (OR 0.94, 95% CI 0.90-0.98) and a 19% increase above this value (OR 1.19, 95% CI, 0.98-1.43). A similar relationship for the composite outcome of death/MI was observed.


CONCLUSIONS
A low baseline haemoglobin level is an independent predictor of the risk of major bleeding in ACS as well as of the risk of death and death and MI. Among other predictors of bleeding risk, baseline haemoglobin should be taken into account in patients presenting with ACS.


BACKGROUND
ClinicalTrials.gov number, NCT00139815. http://clinicaltrials.gov/ct2/show/NCT00139815?term=NCT00139815&rank=1.
Bassand
Jean-Pierre
JP
Department of Cardiology, University Hospital Jean Minjoz, EA 3920, 25000 Besançon, France. jpbassan@univ-fcomte.fr
Afzal
Rizwan
R
Eikelboom
John
J
Wallentin
Lars
L
Peters
Ron
R
Budaj
Andrzej
A
Fox
Keith A A
KA
Joyner
Campbell D
CD
Chrolavicius
Susan
S
Granger
Christopher B
CB
Mehta
Shamir
S
Yusuf
Salim
S
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000628:therapy; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects*; D004311:Double-Blind Method; D017984:Enoxaparin / Q000009:adverse effects; D005260:Female; D000077425:Fondaparinux; D006454:Hemoglobins / Q000378:metabolism*; D006470:Hemorrhage / Q000209:etiology*; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000009:adverse effects; D016896:Treatment Outcome
D000925:Anticoagulants; D017984:Enoxaparin; D006454:Hemoglobins; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux