Bleeding common after acute coronary syndrome

Acute coronary syndrome (ACS) often leads to bleeding events, particularly at gastrointestinal sites, a recent study has found. Such complications are more likely to occur among older patients and those with hypertension, heart failure, and low baseline haemoglobin levels.

Researchers conducted a population-based analysis of 1,379 ACS patients (median age 72 years, 35.5 percent women) followed over a median of 4.6 years. Serious bleeding was defined as intracranial haemorrhage (ICH) or events requiring hospital admission, transfusion, or surgery.

Eighty-five participants experienced at least one bleeding event during the duration of the study, yielding cumulative and 1-year incidence rates of 8.6 percent and 3.0 percent, respectively. Notably, bleeding occurred significantly more frequently in patients ≥75 vs <75 years of age, with corresponding long-term cumulative incidence rates of 13.0 percent and 6.0 percent (p<0.001).

Gastrointestinal bleeding was the most common type of bleeding event, comprising 51 percent (n=43) of all events observed. This was followed by ICH (27 percent; n=23).

Multivariable Cox regression analysis confirmed that age ≥75 years was a significant risk factor for bleeding events (hazard ratio [HR], 2.0, 95 percent confidence interval [CI], 1.2–3.1), as were prior histories of hypertension (HR, 1.8, 95 percent Cim 1.1–2.9) and heart failure (HR, 2.2, 95 percent CI, 1.1–4.5).

In contrast, higher baseline haemoglobin (HR, 0.97, 95 percent CI, 0.96–0.99) and being female (HR, 0.6, 95 percent CI, 0.4–0.97) were protective against bleeding events.

“To decrease bleeding risk after ACS, the future challenge is to identify the vulnerable patient, individualize treatment, and repeatedly re-evaluate bleeding risk during follow-up,” the researchers said.