Skip Navigation


European Heart Journal Advance Access originally published online on April 24, 2007
European Heart Journal 2007 28(10):1193-1204; doi:10.1093/eurheartj/ehm019
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
28/10/1193    most recent
ehm019v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (6)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Rao, S. V.
Right arrow Articles by Bassand, J.-P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rao, S. V.
Right arrow Articles by Bassand, J.-P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes

Sunil V. Rao1,*, John A. Eikelboom2, Christopher B. Granger1, Robert A. Harrington1, Robert M. Califf3 and Jean-Pierre Bassand4

1 The Duke Clinical Research Institute, Durham, NC, USA
2 McMaster University, Hamilton, Ontario, Canada
3 The Duke Translational Medicine Institute, Durham, NC, USA
4 University Hospital Minjoz, Besancon, France

Received 20 September 2006; revised 18 January 2007; accepted 15 February 2007; online publish-ahead-of-print 24 April 2007.

* Corresponding author. Durham VA Medical Center, 508 Fulton Street (111A), Durham, NC 27705, USA. Tel: +1 919 286 0411, ext 2352; fax: +1 919 286 6821. E-mail address: sunil.rao{at}duke.edu

Antithrombotic therapy and invasive risk stratification in selected high-risk patients have improved outcomes from non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but carry a risk of bleeding and blood transfusion. Although the true incidence of bleeding depends on the population studied (i.e. clinical trial vs. registry), the definition used, and the use of invasive procedures, it is becoming clear that bleeding is associated with an increased risk for adverse outcomes including myocardial infarction and death. Blood transfusion itself may carry a risk for ischaemic outcomes that is independent of bleeding. Therefore, therapies that provide an adequate level of anticoagulation to reduce ischaemia while simultaneously minimizing the risk of bleeding and transfusion have the potential to improve outcomes among patients with NSTE-ACS. Anticoagulants studied in recent clinical trials that have focused on bleeding reduction include fondaparinux and bivalirudin. In this review, we discuss the clinical trial evidence for these agents, the association between bleeding and clinical outcomes, the biology of blood transfusion and potential mechanisms underlying its association with adverse outcomes, and propose strategies to deal with bleeding complications. Future directions for research and clinical practice are also discussed.

Key Words: Acute coronary syndromes • Haemorrhage • Blood transfusion


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 HeartHome page
J.-P. Bassand
Bleeding and transfusion in acute coronary syndromes: a shift in the paradigm
Heart, May 1, 2008; 94(5): 661 - 666.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al.
Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology
Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660.
[Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.