Abstract 4007: Has Major In-Hospital Bleeding Increased by Increasing the Use of Antithrombotic and Antiplatelet Agents in the Management of Patients Presenting with an Acute Coronary Syndrome?
BACKGROUND: Antithrombotic and antiplatelet agents are essential for the management of patients with acute coronary syndromes (ACS). These pharmacologic agents have the potential for increased risk of bleeding. It is not clear if the increased uptake of these therapies has resulted in a clinically evident increase in bleeding complications
HYPOTHESIS: Increasing use of antithrombotic and antiplatelet agents in the acute management of ACS will be associated with an increased risk of bleeding complications.
METHODS: Between January 1999 and December 2004, 3193 patients were admitted to the University of Michigan with an ACS (unstable angina or myocardial infarction). These patients were analyzed for temporal trends in antithrombotic and antiplatelet agent use and bleeding complications (including gastrointestinal, vascular access and intracranial hemorrhage). We also examined the trends in the use of thrombolytic therapy, cardiac catheterizations and percutaneous coronary interventions (PCI).
RESULTS: P-values for comparisons of the distributions of the categorical variables among years were calculated using the Cochran-Armitage test for trend.
CONCLUSION: We found a decreasing temporal trend in the incidence of major in-hospital bleeding complications despite an increasing use of anti-platelet agents, unfractionated heparin, Gp IIb/IIIa inhibitors and PCI in the management of patients with acute coronary syndromes. We speculate that this maybe due to better risk stratification of patients, attention to correct dosing and appropriate monitoring.