Incidence And Predictotrs Of Bleeding Among Patients With Acute Coronary Syndrome Using The CRUSADE risk score

Abstract

Bleeding is a potential complication in patients with ACS treated with antithrombotic and/or antiplatelet medications. Prognostic markers of major bleeding are needed to identify patients with acute coronary syndromes (ACS) who are at high risk for adverse events. Although, the value of anti-thrombin and antiplatelet therapy in reducing the risk of ischaemic events is well established, the mechanisms of action that confer the benefits of these therapies have an inherent tendency to increase the risk of bleeding complications. In the current study, we tried to demonstrate the incidence of bleeding either mild or moderate according to GUSTO classification as well as the predictors of bleeding based on the CRUSADE risk score that includes 8 variables composed of sex, DM, prior vascular disease , signs of congestive heart failure, baseline heart rate, baseline blood pressure, baseline haematocrit value, and creatinine clearance. The study population groups had been collected from three tertiary center hospitals, a total number of 823 patients of various age and sex groups. There was increased incidence of bleeding with increased risk scoring. Puncture site hematomas were the most common source of bleeding followed by GIT bleeding. In the current study, demographic factors, like older age , lower body weight, female sex were predictive of increased bleeding events. The underlying co-morbidities like, DM , prior vascular disease were associated with increased bleeding events. The acuity of presentation was predictive of various bleeding events, as demonstrated by increased bleeding events among STEMI patients , patients presented with CHF compared with other clinical entities. Usage of glycoprotein IIbIIIa antagonists particularly with un adjusted doses according to the body weight and renal functions, was associated with increased risk of bleeding. Summary - 111 - So, it is appropriate for every patient presented with acute coronary syndrome to be evaluated meticulously using various risk stratification models. Bleeding events can be aborted or reduced by using the various management plans either pharmacological or interventional that can achieve better benefit with minimal risk with the goal of optimizing outcomes particularly in high risk patients.