title: Relationship between baseline haemoglobin and major bleeding complications in acute coronary syndromes.
abstract: 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.
authors.affiliation: Department of Cardiology, University Hospital Jean Minjoz, EA 3920, 25000 Besançon, France. jpbassan@univ-fcomte.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bassand
authors.forename: Rizwan
authors.initials: R
authors.lastname: Afzal
authors.forename: John
authors.initials: J
authors.lastname: Eikelboom
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Ron
authors.initials: R
authors.lastname: Peters
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Campbell D
authors.initials: CD
authors.lastname: Joyner
authors.forename: Susan
authors.initials: S
authors.lastname: Chrolavicius
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Shamir
authors.initials: S
authors.lastname: Mehta
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006454:Hemoglobins; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux