Bleeding and haemostasis disorders

2018 ◽  
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Coronary Syndrome ◽  
Coronary Syndromes

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).

Bleeding and haemostasis disorders

2021 ◽  
pp. 926-937
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

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).

Bivalirudin, a bivalent, thrombin specific anticoagulant as an alternative to heparin in interventional procedures

2002 ◽  
Vol 22 (03) ◽  
pp. 142-148 ◽  
Author(s):  
D. P. Chew
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
The United States ◽  
Bleeding Complications ◽  
Amino Acid Residues ◽  
Artery Bypass Graft ◽  
Small Peptide ◽  
Percutaneous Coronary ◽  
Coronary Syndromes

SummaryAmong the antithrombotic therapies evaluated to date, the synthetic peptide bivalirudin is unique in its ability to reduce both ischemic and bleeding complications associated with percutaneous coronary intervention (PCI). Bivalirudin is a small peptide consisting of 20 amino acid residues that binds thrombin in a direct, reversible, and bivalent fashion. The agent is approved for use in the United States and New Zealand as an anticoagulant in patients with unstable angina undergoing PCI and may also prove beneficial in patients with acute coronary syndromes (ACS), acute myocardial infarction (AMI) and in patients undergoing coronary artery bypass graft (CABG) procedures. This article examines bivalirudin in more detail.

scholarly journals Is there a place for a multidisciplinary “Heart Team” approach to the selection of myocardial revascularization method in patients with acute coronary syndromes?

2021 ◽  
Vol 26 (2) ◽  
pp. 4210
Author(s):  
O. L. Barbarash ◽  
V. I. Ganyukov ◽  
R. S. Tarasov ◽  
L. S. Barbarash
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Team Approach ◽  
Heart Team ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
Artery Disease ◽  
Selection Of

Current review article, based on foreign and Russian studies, guidelines of the European and North American cardiological and surgical communities, summarizes the expert positions on the place of multidisciplinary “Heart Team” approach in the selection of management strategy for patients with various types of coronary artery disease. The positions of modern clinical guidelines regarding percutaneous coronary intervention and coronary artery bypass grafting in acute coronary syndrome are given. Prospective positions for optimizing the decisionmaking process by a multidisciplinary team when considering difficult patients are presented.

scholarly journals Choice of revascularization method in acute coronary syndrome with non-ST-segment elevation

2021 ◽  
Vol 10 (2) ◽  
pp. 58-62
Author(s):  
A. B. Nishonov ◽  
R. S. Tarasov
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Syndromes

Aim. To analyze the results of various revascularization techniques in high-risk non – STsegment elevation in acute coronary syndromes performed during the first 24 hours.Methods. As a part of a single-center retrospective study, 45 cases of coronary artery bypass grafting (CABG) were examined in high-risk non – ST-segment elevation in acute coronary syndromes patients during the first 24 hours since their hospitalization for the period from 2017 to 2020. 45 cases of percutaneous coronary intervention (PCI) were selected from a similar group of patients with the help of the copy-pair method.Results. The groups were comparable according to such significant factors as age, gender, postinfarction cardiosclerosis, diabetes mellitus, and multifocal atherosclerosis. However, the severity of coronary atherosclerosis according to the Syntax score was significantly higher in the CABG group (p = 0.0004). The groups were comparable in achieving complete revascularization (p = 0.2). In 8.9% (n = 4) of patients in the PCI group, unscheduled repeated revascularization was required, and in 15.6% (n = 7) of cases stent restenosis/thrombosis was detected during the hospital period and between PCI stages, while in the CABG group, congenital malformations and dysfunction were not found. Mortality in the groups did not differ significantly (4 (8.8%) versus 2 (4.4%), p = 0.4).Conclusion. CABG provides freedom from repeated revascularizations, despite the initially more severe coronary lesion. 

scholarly journals Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

2018 ◽  
Vol 118 (05) ◽  
pp. 929-938 ◽  
Author(s):  
Alberto Garay ◽  
Francesc Formiga ◽  
Sergio Raposeiras-Roubín ◽  
Emad Abu-Assi ◽  
José Sánchez-Salado ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Roc Curves ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine–Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92–2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients.

scholarly journals Quality of Life Changes in Acute Coronary Syndromes Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (18) ◽  
pp. 6889
Author(s):  
Billingsley Kaambwa ◽  
Hailay Abrha Gesesew ◽  
Matthew Horsfall ◽  
Derek Chew
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Treatment Options ◽  
Coronary Intervention ◽  
Mean Difference ◽  
Coronary Syndrome ◽  
Coronary Syndromes

There is little up-to-date evidence about changes in quality of life following treatment for acute coronary syndrome (ACS) patients. The main aim of this review was to assess the changes in QoL in ACS patients after treatment. We undertook a systematic review and meta-analysis of quantitative studies. The search included studies that described the change of QoL of ACS patients after receiving treatment options such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT). We synthesized findings using content analysis and pooled the estimates using meta-analysis. We used the PRISMA guidelines to select and appraise the studies and report the findings. Twenty-nine (29) articles were included in the review. We found a significant improvement of QoL in ACS patients after receiving treatment. Particularly, the meta-analytic association found that the mean QoL of patients diagnosed with ACS was higher after receiving treatment compared to baseline (overall pooled mean difference = 31.88; 95% CI = 31.64–52.11, I2 = 98) with patients on PCI having slightly lower QoL gains (pooled mean difference = 30.22; 95% CI = 29.9–30.53, I2 = 0%) compared to those on CABG (pooled mean difference = 34.01; 95% CI = 33.66–34.37, I2 = 0%). The review confirmed that QoL of ACS patients improved after receiving treatment therapies although varied by the treatment options and patients’ preferences. This suggests the need to perform further study on the QoL, patient preferences and physicians’ decision to prescription of treatment options.

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