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

Publication ,  Journal Article
Rao, SV; Eikelboom, JA; Granger, CB; Harrington, RA; Califf, RM; Bassand, J-P
Published in: Eur Heart J
May 2007

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.

Duke Scholars

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2007

Volume

28

Issue

10

Start / End Page

1193 / 1204

Location

England

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Humans
  • Hemorrhage
  • Cardiovascular System & Hematology
  • Blood Transfusion
  • Anticoagulants
  • Acute Coronary Syndrome
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
 

Citation

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ICMJE
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Rao, S. V., Eikelboom, J. A., Granger, C. B., Harrington, R. A., Califf, R. M., & Bassand, J.-P. (2007). Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J, 28(10), 1193–1204. https://doi.org/10.1093/eurheartj/ehm019
Rao, Sunil V., John A. Eikelboom, Christopher B. Granger, Robert A. Harrington, Robert M. Califf, and Jean-Pierre Bassand. “Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes.Eur Heart J 28, no. 10 (May 2007): 1193–1204. https://doi.org/10.1093/eurheartj/ehm019.
Rao SV, Eikelboom JA, Granger CB, Harrington RA, Califf RM, Bassand J-P. Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007 May;28(10):1193–204.
Rao, Sunil V., et al. “Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes.Eur Heart J, vol. 28, no. 10, May 2007, pp. 1193–204. Pubmed, doi:10.1093/eurheartj/ehm019.
Rao SV, Eikelboom JA, Granger CB, Harrington RA, Califf RM, Bassand J-P. Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007 May;28(10):1193–1204.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2007

Volume

28

Issue

10

Start / End Page

1193 / 1204

Location

England

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Humans
  • Hemorrhage
  • Cardiovascular System & Hematology
  • Blood Transfusion
  • Anticoagulants
  • Acute Coronary Syndrome
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology