PMID- 19882079
OWN - NLM
STAT- MEDLINE
DCOM- 20100430
LR  - 20091102
IS  - 0720-9355 (Print)
IS  - 0720-9355 (Linking)
VI  - 29
IP  - 4
DP  - 2009 Nov
TI  - Acute Coronary Syndromes and Percutaneous Coronary Interventions: impact of 
      bleeding and blood transfusion.
PG  - 381-7
AB  - Activation of the coagulation cascade and platelet functions occurs in ACS and 
      may lead to subsequent thrombus formation, vessel occlusion, distal embolisation, 
      myocardial ischaemia, necrosis and eventually death. Over the last 20 years, the 
      outcome of ACS and PCI patients has considerably improved, thanks to better 
      pharmacologic environment, urgent reperfusion in STEMI (ST elevation myocardial 
      infarction), timely revascularisation in non-ST elevation ACS (NSTEACS) and 
      improved PCI techniques, particularly widespread use of stents. In this context, 
      bleeding was long considered as inherent to the modern therapeutic approach and 
      without real consequences. Actually, bleeding has a strong impact on outcome, 
      with a four- to five-fold increase in the rate of death, myocardial infarction 
      and stroke at 30 days and six months. In addition, blood transfusion may have 
      deleterious effects. Recent evidence shows that reduced risk of bleeding leads to 
      a reduced risk of ischemic events (death, myocardial infarction and stroke). The 
      exact mechanisms by which bleeding impacts on outcome are as yet poorly 
      understood. The interruption of active treatment may play an important role. 
      Activation of coagulation or inflammation in case of bleeding, and depletion of 
      2,3DPG and nitric oxide, inflammatory and immunologic reactions triggered by 
      blood transfusion, are among the potential mechanisms. Prevention of bleeding has 
      become as important as prevention of ischaemic events. Risk stratification for 
      bleeding is as important as overall risk stratification for further ischaemic 
      events. In patients at high risk of bleeding, appropriate choice and dosage of 
      drugs, combinations of drugs, and the use of radial rather than femoral approach 
      are essential components of bleeding prevention.
FAU - Bassand, J-P
AU  - Bassand JP
AD  - Department of Cardiology, University Hospital Jean Minjoz, Besancon, France. 
      jpbassan@univ-fcomte.fr
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Germany
TA  - Hamostaseologie
JT  - Hamostaseologie
JID - 8204531
SB  - IM
MH  - Acute Coronary Syndrome/complications/*drug therapy
MH  - Age Factors
MH  - Blood Coagulation
MH  - Blood Transfusion
MH  - Female
MH  - Hemorrhage/etiology/prevention & control
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Myocardial Infarction/etiology/*therapy
MH  - Platelet Activation
MH  - Risk Assessment
MH  - Stents
MH  - Thrombosis/*etiology
RF  - 66
EDAT- 2009/11/03 06:00
MHDA- 2010/05/01 06:00
CRDT- 2009/11/03 06:00
PHST- 2009/11/03 06:00 [entrez]
PHST- 2009/11/03 06:00 [pubmed]
PHST- 2010/05/01 06:00 [medline]
AID - 09040381 [pii]
PST - ppublish
SO  - Hamostaseologie. 2009 Nov;29(4):381-7.