Fibrinolytic therapy and bleeding complications: risk predictors from RIKS-HIA.
BACKGROUND
Fibrinolytic treatment for ST-elevation myocardial infarction is associated with increased bleeding risk but is still widely used world wide, mainly because of limited access to primary PCI.


OBJECTIVE
To analyse contemporary fibrinolytic treatment patterns, in-hospital bleeding risk and prognosis during 2001 to 2006 in unselected Swedish patients.


RESULTS
The RIKS-HIA registry covers almost all Swedish patients treated for acute coronary syndromes. Major in-hospital bleeding was defined as lethal or intracranial bleeding or bleeding requiring surgery or blood transfusion. Survival status of the 15 373 patients was obtained from the National Cause of Death Register. The number of patients receiving fibrinolysis as reperfusion therapy decreased from 4336 patients in 2001 to 733 in 2006. Cases of major in-hospital bleeding increased from 1.2% (including 0.7% lethal or intracranial) in 2001 to 4.0% (1.1%) in 2006, p<0.001. Higher age, female gender, hypertension, kidney failure, clopidogrel treatment before admission, pre-hospital administration of fibrinolysis and fibrin-specific fibrinolytic agents were identified as predictors for bleeding. Major in-hospital bleeding was the strongest predictor of adverse prognosis with a more than threefold increase in 1-year mortality.


CONCLUSIONS
During 2001 to 2006 the use of fibrinolytic treatment markedly decreased while the incidence of major bleeding complications more than doubled. The latter might in part be explained by increasing use concomitant antiplatelet therapy, pre-hospital treatment and fibrin-specific fibrinolytic agents. Future close monitoring of bleeding complications is warranted, especially when considering the increased use of various combinations of antithrombotic drugs in conjunction with fibrinolysis and the great impact of bleeding on long-term mortality.
Oldgren
Jonas
J
Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. jonas.oldgren@ucr.uu.se
Wernroth
Lisa
L
Stenestrand
Ulf
U
D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D013548:Sweden / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data / Q000639:trends
D005343:Fibrinolytic Agents