European Heart Journal Advance Access originally published online on August 18, 2008
European Heart Journal 2009 30(6):655-661; doi:10.1093/eurheartj/ehn358
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes
1 Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland
2 Department of Medicine, McMaster University, Sixth Floor, McMaster Wing, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada
3 Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
4 University Hospital Jean Minjoz, Besançon, France
5 University and the Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
6 Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
7 Academic Medical Center, Amsterdam, The Netherlands
8 Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
9 Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Received 11 January 2008; revised 12 July 2008; accepted 17 July 2008; online publish-ahead-of-print 18 August 2008.
* Corresponding author. Tel: +1 905 527 4322 (ext. 44478), Fax: +1 905 521 1551, Email: eikelbj{at}mcmaster.ca
Aims: Bleeding in patients with coronary artery disease has been linked with adverse outcomes. We examined the incidence and outcomes after bleeding in 20 078 patients with acute coronary syndromes (ACS) enrolled in the OASIS-5 trial who were treated with fondaparinux or the low-molecular weight heparin, enoxaparin.
Methods and results: Nine hundred and ninety (4.9%) patients developed major bleeding and 423 (2.1%) developed minor bleeding. Fondaparinux compared with enoxaparin reduced fatal bleeding [0.07 vs. 0.22%, relative risk (RR) 0.30, 95% CI: 0.13–0.71], non-fatal major bleeding (2.2 vs. 4.2%, RR 0.52, 95% CI: 0.44–0.61), minor bleeding (1.1 vs. 3.2%, RR 0.34, 95% CI: 0.27–0.42), and need for transfusion (1.8 vs. 3.1%, RR 0.56, 95% CI: 0.47–0.61) during the first 9 days. One of every six deaths during the first 30 days occurred in patients who experienced bleeding. Cox proportional hazards model revealed that major bleeding was associated with about a four-fold increased hazard of death, myocardial infarction, or stroke during the first 30 days and about a three-fold increased hazard during 180 days of follow up.
Conclusion: Bleeding in patients with ACS is a powerful determinant of fatal and non-fatal outcomes. Reducing the risk of bleeding using a safer anticoagulant strategy during the first 9 days is associated with substantial reductions in morbidity and mortality.
Key Words: Bleeding • Fondaparinux • Enoxaparin • Acute coronary syndrome
Both the authors contributed equally to this work.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J.-P. Bassand A reduction in bleeding in acute coronary syndromes? Let's not rain on the parade! Eur. Heart J., December 27, 2009; (2009) ehp577v1. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Eikelboom, D. J. Quinlan, and M. O'Donnell Major Bleeding, Mortality, and Efficacy of Fondaparinux in Venous Thromboembolism Prevention Trials Circulation, November 17, 2009; 120(20): 2006 - 2011. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Brener Antithrombin Therapy for Elective Percutaneous Coronary Intervention: Which Agent to Use? Does It Matter? J. Am. Coll. Cardiol. Intv., November 1, 2009; 2(11): 1092 - 1094. [Full Text] [PDF]
|
|
|
|
|
|
E. S. van Hattum, A. Algra, J. A. Lawson, B. C. Eikelboom, F. L. Moll, and M. J.D. Tangelder Bleeding Increases the Risk of Ischemic Events in Patients With Peripheral Arterial Disease Circulation, October 20, 2009; 120(16): 1569 - 1576. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome. J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1544 - 1555. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ahmed, W. D. Piper, D. Malenka, P. VerLee, J. Robb, T. Ryan, M. Herne, W. Phillips, and H. L. Dauerman Significantly Improved Vascular Complications Among Women Undergoing Percutaneous Coronary Intervention: A Report From the Northern New England Percutaneous Coronary Intervention Registry Circ Cardiovasc Interv, October 1, 2009; 2(5): 423 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Jolly, D. P. Faxon, K. A.A. Fox, R. Afzal, W. E. Boden, P. Widimsky, P. G. Steg, V. Valentin, A. Budaj, C. B. Granger, et al. Efficacy and safety of fondaparinux versus enoxaparin in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors or thienopyridines: results from the OASIS 5 (Fifth Organization to Assess Strategies in Ischemic Syndromes) trial. J. Am. Coll. Cardiol., July 28, 2009; 54(5): 468 - 476. [Abstract] [Full Text] [PDF]
|
|