Factors associated with inhospital severe bleeding in noninvasively treated patients with non ST elevation acute coronary syndrome

UNLABELLED: Risk factors of bleeding in acute coronary syndrome (ACS) were derived from data of clinical trials and registers with high proportion of invasively treated patients. Aim of this study was to elucidate factors associated with severe bleeding in patients with non ST-elevation (NSTE) ACS treated in a noninvasive hospital. MATERIAL AND METHODS: From November 2009 to April 2011 24 NSTEACS patients had severe GUSTO or TIMI bleeding. For each of these patients we selected 3 age matched controls without severe bleeding from hospital registry of ACS in which we included 25 consecutive patients each month during about the same period of time. RESULTS: The group of patients with severe bleeding compared with control group (n = 72) had greater portions of patients with Killip class > or = 2 (50.0% vs 16.7%; p = 0.002), with history of chronic renal failure (20.8% vs 4.2%; p = 0.02) or bleeding (16.7 vs 2.8%, p = 0.03), with admission creatinine clearance 140 (75.0 vs 45.8%, p = 0.01). Patients with bleeding prehospitally less frequently received aspirin (25.0 vs 58.3%, p = 0.005) and parenteral anticoagulants (16.7 vs 38.9%, p = 0.04), while in hospital they were more frequently given diuretics (62.5 and 26.4%, p = 0.005) and less frequently--low molecular weight heparin (8.3 vs 20.8%, p = 0.045) while use of parental anticoagulants was similar in both groups (87.5 vs 91.7%, respectively). Mortality and rate of inhospital myocardial infarctions in groups with and without bleeding were 62.5 and 1.4%, 21.7 and 1.4%, respectively. CONCLUSIONS: Inhospital severe bleeding in noninvasively treated patients with NSTEACS was associated with: well known predictors (heart and renal failure, history of bleeding); high risk of ischemic events and therefore very high mortality; lesser use of some antithrombotic drugs at various stages of treatment.