Abstract
In recent years, guidelines for the management of acute coronary syndromes (ACS) have placed more emphasis on identifying patients at high bleeding risk (HBR). We set out to investigate the prevalence of HBR patients according to the Academic Research Consortium for High Bleeding Risk (ARC–HBR) criteria in hospitalized patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients were retrospectively enrolled between January and June 2019 from the emergency department (ED) of a tertiary hospital. The discharge diagnosis and baseline data were manually collected using electronic patient records and database searches. Patients with non-cardiac diagnoses were excluded. Overall, 212 patients were included in the study. A total of 146 (68.9%) patients were diagnosed with NSTEMI (Type 1), 47 (22.2%) with unstable angina pectoris (UAP) and 19 (9.0%) with “other.” HBR was detected in 47.6% (n = 101) of all patients. Common criteria for HBR among ACS patients were age (40.4%), chronic kidney disease (33.7%), and the use of oral anticoagulation medicines (20.2%). In conclusion, nearly half of the patients hospitalized for ACS fulfilled HBR criteria. According to contemporary guidelines, the management of HBR patients differs from that of non-HBR patients, and thus, a more comprehensive screening for HBR may be considered in clinical practice.
Highlights
IntroductionThe benefit of dual antiplatelet therapy (DAPT) in reducing further thrombotic events in acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) is well established by numerous studies [1–5]
The search identified a total of 2562 patients, 432 of whom were hospitalized, and after selecting those with non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP) diagnosis codes, 212 patients were included in this study
Our study indicates that high bleeding risk (HBR) is frequently encountered in this patient group, with almost half of the patients fulfilling Academic Research Consortium for High Bleeding Risk (ARC–HBR) criteria
Summary
The benefit of dual antiplatelet therapy (DAPT) in reducing further thrombotic events in acute coronary syndromes (ACS) after percutaneous coronary intervention (PCI) is well established by numerous studies [1–5]. It comes with a price of increased bleeding complications [2,5,6]. Identifying patients at high bleeding risk (HBR) in this group could be important in reducing bleeding complications associated with ACS management. Major bleeding has been shown to be an independent predictor for mortality, equaling the risk associated with ischemic complications [7–11]. A recent study demonstrated that the clinical presentation of ACS per se predicts increased bleeding risk, as compared to chronic coronary syndrome, further emphasizing the importance of considering these two aspects during decision making [14]
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