Bleeding risk stratification in patients admitted for acute coronary syndrome
S Paula, M Figueiredo, M Coelho, M Santos, S Almeida, L AlmeidaAbstract
Funding Acknowledgements
None.
Introduction
The risk of hemorrhagic events should always be accounted for in patients admitted with acute coronary syndromes (ACS). With the increasing frailty of these patients, it is important to identify them and minimize the risk of such events.
Purpose
Identify high-risk patients admitted for ACS for hemorrhagic events during their hospital stay.
Methods
Multicenter retrospective study, data collected from 1/10/2010 and 31/12/2020 with ACS diagnosis. Patients were divided into 3 groups according to hemoglobin (Hb) and platelet (Plat) levels. Group 1 – Hb <8g/dl, Plat <150x109/L; Group 2 – Hb 8-12g/dl, Plat 150-450x109/L; Group 3 – Hb ≥12g/dl, Plat ≥450x109/L. We further divided these patients according to a composite endpoint. Group A without the composite endpoint; Group B with composite endpoint. This composite endpoint was defined as major hemorrhage, intracranial hemorrhage, need of blood transfusions and a Hb decrease of ≥ 2g/dl.
Results
19409 patients were enrolled, of those 4707 (24.3%) had the composite endpoint. Group B was older (68±13 vs 66±12, p<0.001), had higher rates of arterial hypertension (72.5% vs 68.2%, p<0.001), diabetes mellitus (35.6% vs 30.7%, p< 0.001), stroke (9.0% vs 6.6%, p < 0.001) and previous haemorrhage (p= 0.004). No statistically significant differences regarding previous MI (p= 0.240). Hb levels <8g/dL (8.1% vs 0.6%, p<0.001) were associated with a higher risk of hemorrhagic events but not lower levels of Plat, instead higher levels (> 450x109/L) were event associated (1.8% vs 0.9%, p<0.001). The choice of femoral access was related to an increased risk of hemorrhagic events (p<0.001). Logistic regression confirmed that the Hb levels < 12g/dL when compared with normal levels were related to the composite endpoint proportionally to the degree of anemia, the lower the level of Hb the more likely these events occur, Hb <8g/dL p<0.001, OR 4.02, CI (95%) 2.50-6.47 and Hb 8-12g/dL, p<0.001, OR 0.761, CI (95%) 0.693-0.837. Survival analysis also showed that cardiovascular (CV) mortality and re-admission at 1 year were related to the degree of anemia.
Conclusion
Lower levels of Hb correlated well and proportionally to the occurrence of the composite endpoint as well as cardiovascular (CV) mortality and re-admission at 1 year. Contrarily to expected lower levels of Plat did not correlate with a higher risk of hemorrhagic events but instead thrombocytosis did, as a paradoxical risk of bleeding has been noted in patients with thrombocytosis, especially extreme thrombocytosis.