In-hospital bleeding in elderly patients with acute coronary syndrome: are potent antiplatelet agents safe?

K Keskin, S Sigirci, A Gurdal, M Sumerkan, O S Ser, H Kilci, E Kalender, O Alyan
2021 European Heart Journal  
Background Despite implementation of newer interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome continue to be prone to in-hospital bleeding compared to their younger patients. Purpose To investigate in-hospital bleeding events, define the bleeding sites, characteristics and associated factors in elderly patients with acute coronary syndrome. Methods Patients 75 years or over who were admitted with acute coronary syndrome were included in the study.
more » ... he definition of in-bleeding was defined as any bleeding requiring transfusion or clinically significant bleeding that altered the treatment course. The main outcome of the study was to find out the incidence of in-hospital bleeding events and associated risk factors. We also wanted to define the bleeding sites, characteristics as well as 1-year all-cause mortality with respect to in-hospital bleeding. Results Overall, 539 patients were included in the study. Mean age was 82.5±4.8 years and 282 (52.3%) patients were female. Of these patients 69 (12.8%) developed in-hospital bleeding. The most common site for bleeding was urinary tract followed by access site bleeding. Factors that were independently related with in-hospital bleeding were age (OR: 1.08; 1.01–1.14 CI 95%; p=0.01), acute kidney injury (OR: 3.66; 2.01–6.69 CI 95%; p<0.01), tirofiban (OR: 4.43; 1.78–10.99 CI 95%; p<0.01) and ticagrelor (OR: 1.93; 1.01–3.73 CI 95%; p=0.04) administration. The patients who developed in-hospital bleeding had also higher one-year all-cause mortality (p [log-rank] = 0.01). Conclusion In-hospital bleeding continues to be a frequent problem among older patients with acute coronary syndrome. Ticagrelor and tirofiban should be used cautiously. In addition to access site bleeding, urinary tract bleeding events were also common. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Table 2
doi:10.1093/eurheartj/ehab724.2802 fatcat:ivzasmyijbbejcxhx7plsod2fi