Temporal Trends in Antiplatelet/Antithrombotic Use in Acute Coronary Syndromes and In-Hospital Major Bleeding Complications
| Autor: | Umesh U. Tamhane, Apurva A. Motivala, Eva Kline Rogers, Kim A. Eagle, Mauro Moscucci, Jin Li, Hitinder S. Gurm, James B. Froehlich, Fadi Saab |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Ticlopidine Percutaneous Myocardial Infarction Vascular access Hemorrhage Fibrinolytic Agents Internal medicine Antithrombotic medicine Humans Thrombolytic Therapy Angina Unstable Myocardial infarction Acute Coronary Syndrome Angioplasty Balloon Coronary Aged Heparin Unstable angina business.industry Incidence (epidemiology) Middle Aged medicine.disease Clopidogrel Increased risk Cardiology Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Major bleeding |
| Zdroj: | The American Journal of Cardiology. 100:1359-1363 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2007.06.023 |
| Popis: | Antithrombotic and antiplatelet agents are essential for the management of patients with acute coronary syndromes (ACSs). These pharmacologic agents have the potential for increased risk of bleeding. It is not clear if the increased uptake of these therapies has resulted in a clinically evident increase in bleeding complications over time. In this study, we included 3,193 consecutive patients who were admitted to the University of Michigan with an ACS (unstable angina or myocardial infarction) between January 1999 and December 2004. These patients were analyzed for temporal trends in antithrombotic and antiplatelet agent use, thrombolytic therapy, cardiac catheterizations, percutaneous coronary interventions, and major bleeding complications (including gastrointestinal, vascular access, and intracranial hemorrhage). We found a decreasing temporal trend in the incidence of major in-hospital bleeding complications (p0.001) despite an increasing use of ticlopidine/clopidogrel (p0.0001), unfractionated heparin (p0.01), glycoprotein IIb/IIIa inhibitors (p0.0001), and percutaneous coronary intervention (p0.0001) in the management of patients with ACSs. In conclusion, major bleeding remains a significant complication of ACS management but has decreased significantly over time. We believe that this decreasing bleeding trend may be because of better identification of higher risk patients, attention to correct dosing, appropriate monitoring, and incorporation of various periprocedural strategies in routine clinical practice. |
| Databáze: | OpenAIRE |
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