Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes
Sunil V Rao1, John A Eikelboom, Christopher B Granger
1The Duke Clinical Research Institute, Durham, NC, USA. sunil.rao@duke.edu
Insights
Minimizing bleeding and transfusion risks in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is crucial. New anticoagulant therapies aim to reduce ischemia while improving patient outcomes by lowering bleeding complications.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Antithrombotic therapy and invasive risk stratification improve outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
- These treatments increase the risk of bleeding and blood transfusion, which are linked to adverse outcomes like myocardial infarction and death.
- Blood transfusion may independently increase ischemic risk.
Purpose of the Study:
- To review clinical trial evidence for anticoagulants focusing on bleeding reduction in NSTE-ACS.
- To discuss the association between bleeding and adverse clinical outcomes.
- To explore blood transfusion biology and its link to adverse outcomes, proposing management strategies.
Main Methods:
- Review of clinical trial data for anticoagulants like fondaparinux and bivalirudin.
- Analysis of studies linking bleeding events to clinical outcomes.
- Examination of the biological mechanisms of blood transfusion and associated risks.
Main Results:
- Bleeding complications are associated with increased risk of myocardial infarction and death in NSTE-ACS patients.
- Blood transfusion may independently contribute to ischemic events.
- Fondaparinux and bivalirudin are anticoagulants studied for bleeding reduction in NSTE-ACS.
Conclusions:
- Therapies reducing bleeding and transfusion risk while maintaining anticoagulation are needed for NSTE-ACS.
- Understanding the link between bleeding, transfusion, and adverse outcomes is key.
- Future research should focus on optimizing anticoagulant strategies and managing bleeding complications in NSTE-ACS.
Abstract:
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.
More Related Videos
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
02:45Blood Transfusion and Agglutination
History
The history of blood transfusion dates back to the 17th century, when early attempts were made in animals. In 1818 James Blundell, a British doctor, performed the first successful human blood transfusion. Later in 1900, Karl...
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:15Blood Transfusion
Blood Transfusion Overview
A blood transfusion is a medical procedure used to replace blood lost due to injury, surgery, or to treat conditions such as anemia or cancer. During a transfusion, donor blood is...
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care