Bleeding and haemostasis disorders

2015 ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Complications ◽  
Cardiac Care ◽  
Preventive Strategy ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Haemostatic Agents ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Cardiac Care Unit

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.

Bleeding and haemostasis disorders

2017 ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Complications ◽  
Cardiac Care ◽  
Preventive Strategy ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Haemostatic Agents ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Cardiac Care Unit

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drug usage (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), such thrombotic microangiopathies as thrombotic thrombocytopenic purpura and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.

Bleeding and haemostasis disorders

2016 ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Complications ◽  
Cardiac Care ◽  
Preventive Strategy ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Haemostatic Agents ◽  
Transfusion Requirements ◽  
Increased Risk ◽  
Cardiac Care Unit

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke). To reduce the need of transfusion, haemostatic agents that decrease blood loss and transfusion requirements (antifibrinolytic amino acids, plasmatic prothrombin complex concentrates, recombinant factor VIIa) may be considered. However, the efficacy of these agents in the control of bleeding complications in acute coronary syndrome is not unequivocally established, and there is concern for an increased risk of re-thrombosis. A low platelet count is another cause of bleeding in the intensive cardiac care unit. The main aetiologies are drugs (unfractionated heparin and glycoprotein IIb/IIIa inhibitors), thrombotic microangiopathies, such as thrombotic thrombocytopenic purpura, and disseminated intravascular coagulation, that are often paradoxically associated with thrombotic manifestations. In conclusion, evidence-based recommendations for the management of bleeding in patients admitted to the intensive cardiac care unit are lacking. Accurate assessments of the risk of bleeding in the individual and prevention measures are the most valid strategies.

scholarly journals Platelet Volume Indices in Patients with Acute Coronary Syndrome

2020 ◽  
pp. 1-5
Author(s):  
Ekta Paramjit ◽  
S. Sudhamani ◽  
Anita Sharan ◽  
Sonali Pitale ◽  
Prakash Roplekar
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Care ◽  
Platelet Volume ◽  
Distribution Width ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Cardiac Care Unit

Background & Aims: Acute coronary syndrome is one of the leading causes of morbidity and mortality in the world and platelet hyperactivity with local platelet activation plays a crucial role in its genesis. As there is discrepancy regarding the significance of deranged platelet parameters, we aimed to study the role of platelet volume indices in the spectrum of coronary artery syndrome and to correlate them clinically. Study Design: The study was conducted by collecting the data of patients with Myocardial infarction from the Cardiac care unit registry along with their clinical history and investigations. Stable coronary artery cases were collected from the Catheterization Lab and compared with Age and Sex matched controls. All CBCs of the above groups were processed by a 5-part counter and the data generated was transferred to a master chart for statistical analysis. Place and Duration of study: The study was conducted in the Central Laboratory & Department of Pathology at D.Y. Patil Hospital, Navi Mumbai, India in collaboration with the Cardiac Care Unit and Catheterisation Lab of the hospital for a period of two years. Methods: A total of 122 cases were studied and grouped into 5 groups according to presentation and the platelet volume indices of these were compared with 38 matched controls and statistically analysed. Results: Mean Platelet Volume and Platelet Distribution Width of patients with ST elevation Myocardial Infarction (STEMI) and Non ST elevation Myocardial Infarction(NSTEMI) were increased marginally in number when compared to Stable Coronary Artery Disease(SCAD) and Control group, however this was not statistically significant. Platelet Large Cell Ratio (PLCR) was significantly raised in STEMI cases only (P = 0.09), so it may prove to be a better marker for the disease (P = 0.09). Platelet counts in various groups when compared with controls gave inconsistent results i.e SCAD vs Control significantly decreased (P = 0.07) and STEMI vs Control significantly increased (P = 0.01). Conclusion: The platelet volume indices in suspected acute coronary syndrome cases showed various changes, but present data failed to be diagnostically significant. However this data may later help to characterise further relationship between Acute coronary syndrome and platelet function in subsequent studies.

scholarly journals The Role of the Transradial Approach for Complex Coronary Interventions in Patients with Acute Coronary Syndrome

2013 ◽  
Vol 8 (2) ◽  
pp. 81
Author(s):  
Sasko Kedev ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Significant Proportion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Elderly Subjects ◽  
Emergency Setting ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Increased Risk

Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A significant proportion of such bleedings are related to the access site, and adoption of transradial access (TRA) may reduce these complications. In patients with ST-segment elevation myocardial infarction (STEMI), TRA reduced cardiac mortality in comparison with the femoral approach (TFA). High-risk patients such as women, obese patients and elderly subjects who are at increased risk for vascular complications and bleeding, might particularly benefit from the TRA. However, specific radial expertise providing procedural time and a success rate comparable to those with the TFA are strongly recommended before using this technique in the emergency setting.

scholarly journals Clinical Trial Perspective: Optimizing Crossover From Ticagrelor to Clopidogrel in Patients with Acute Coronary Syndrome (CAPITAL OPTICROSS)

2017 ◽  
Vol 11 (2) ◽  
pp. 59
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Clinical Trial ◽  
Acute Coronary Syndrome ◽  
Platelet Inhibition ◽  
Initial Therapy ◽  
Loading Dose ◽  
Platelet Activity ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Recommended Treatment ◽  
Increased Risk

Guideline-recommended treatment in patients with acute coronary syndrome is dual anti-platelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, with clopidogrel or ticagrelor the preferred options for initial therapy. Ticagrelor has been demonstrated to have improved efficacy, and is preferred over clopidogrel in the absence of contraindications or the need for oral anticoagulation. However, it is not uncommon that patients are switched to clopidogrel after starting on ticagrelor. Reasons for this may be related to recognition of the increased risk of bleeding, the higher costs of ticagrelor, or adverse effects such as adenosine-mediated dyspnea. It is therefore important to understand the optimal dosing strategy in patients undergoing a switch from ticagrelor to clopidogrel. A loading dose of clopidogrel is standard when initiating therapy for acute coronary syndrome or before coronary stenting. However, whether this is required in patients who have already achieved adequate platelet inhibition with ticagrelor is unknown. Owing to the short half-life of the unbound active metabolite of clopidogrel at standard doses, there are concerns of high on-treatment platelet activity for a period of time following switching. However, this must be balanced against concerns of an increased risk of bleeding if a loading dose is used. To investigate this, the Optimizing Crossover From Ticagrelor To Clopidogrel In Patients With Acute Coronary Syndrome (CAPITAL OPTICROSS) clinical trial was conducted to compare a clopidogrel bolus dose with no bolus among patients currently treated with ticagrelor and whose treating physician had decided to switch therapy to clopidogrel. This review summarizes the CAPITAL OPTICROSS trial and its findings, and discusses the implications for clinical practice.

scholarly journals The Effect of Warm Footbath on the Quality of Sleep on Patients with Acute Coronary Syndrome in Cardiac Care Unit

2019 ◽  
Vol 8 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Hassan Talebi Ghadicolaei ◽  
Mohammad Ali Heydary Gorji ◽  
Babak Bagheri ◽  
Jamshid Yazdani charati ◽  
Zoya Hadinejad
Keyword(s):  
Acute Coronary Syndrome ◽  
Sleep Quality ◽  
Sleep Disorders ◽  
Cardiac Care ◽  
Control Group ◽  
Quality Of Sleep ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Cardiac Care Unit

Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit. Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests. Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05). Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.

scholarly journals Effect of aromatherapy on anxiety in patients with acute coronary syndrome hospitalized in cardiac care unit

2017 ◽  
Vol 6 (2) ◽  
pp. 331 ◽  
Author(s):  
Mahmood Reza Nematollahi ◽  
Javad Bazeli ◽  
Mahdi Basiri Moghaddam ◽  
Hossein Aalami
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Care ◽  
Coronary Syndrome ◽  
Cardiac Care Unit
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