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In-Hospital Bleeding in Elderly Patients With Acute Coronary Syndrome: Are Potent Antiplatelet Agents Safe?
Kudret Keskin1,2, Serhat Sığırcı1,2, Ahmet Gürdal1,2
1Department of Cardiology, 64159Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.
Insights
Elderly patients with acute coronary syndrome (ACS) have a high risk of in-hospital bleeding. Ticagrelor and tirofiban use increases this risk, with urinary tract bleeding being most common.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Research
Background:
- Elderly patients with acute coronary syndrome (ACS) face higher in-hospital bleeding risks despite advances.
- Understanding bleeding incidence and risk factors in this demographic is crucial for patient safety.
Purpose of the Study:
- To investigate the incidence, risk factors, bleeding sites, and mortality associated with in-hospital bleeding in elderly ACS patients (≥75 years).
Main Methods:
- Retrospective study of 539 elderly ACS patients.
- Bleeding events defined by Bleeding Academic Research Consortium (BARC) types 2, 3, or 5.
- Multivariable analysis to identify independent risk factors for bleeding.
Main Results:
- 12.8% of elderly ACS patients experienced in-hospital bleeding.
- Independent risk factors included advanced age, acute kidney injury, and administration of tirofiban and ticagrelor.
- The urinary tract was the most common bleeding site, followed by femoral arteries.
Conclusions:
- Ticagrelor and tirofiban necessitate cautious use in elderly ACS patients due to increased bleeding risk.
- Targeting modifiable risk factors like acute kidney injury may help reduce bleeding events.
Abstract:
Despite implementation of new interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome (ACS) continue to be susceptible to in-hospital bleeding compared with younger ones. Thus, we investigated the incidence of in-hospital bleeding events and associated risk factors in elderly (≥ 75°years) ACS patients. We also wanted to define the bleeding sites, characteristics, and associated mortality. Bleeding Academic Research Consortium (BARC) classification type 2, 3, or 5 was used to define bleeding events. Overall, 539 patients were included in the study (mean age: 82.5 ± 4.8°years; 282 (52.3%) females). Of these patients, 69 (12.8%) developed in-hospital bleeding. Factors that were independently related with in-hospital bleeding were age (odds ratio (OR): 1.08; 95% confidence interval (CI): 1.011.14, P = .01), acute kidney injury (OR: 3.66; 95% CI: 2.016.69; P < .01), tirofiban (OR: 4.43; 95% CI: 1.7810.99; P < .01), and ticagrelor (OR: 1.93; 95% CI: 1.013.73; P = .04) administration. The urinary tract was the most frequent bleeding site, followed by femoral arteries. In conclusion, ticagrelor and tirofiban should be used with caution in elderly ACS patients.
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