| Summary: | Hemorrhagic complications have been strongly linked with subsequent morbidity and mortality in patients with acute coronary syndromes (ACS).
Objectives: To determine the incidence and predictors of major bleeding and its impact on outcomes, including mortality, in patients with ACSs.
Methods: Patients (n_ 200) with ACS, clinical data, management strategies, complications and outcome were reported in case report form. Factors associated with major bleeding were identified using logistic regression analysis and impact of major bleeding on outcomes, including mortality was reported.
Results: Bleeding occurred in 41 pts (20.5%), and was classified as nuisance (15 pts, 7.5%), minor (21pts, 10.5%) and major bleeding (5pts, 2.5%). Advanced age (p = 0.02), interventional coronary procedures (p = 0.001), low BMI (p = 0.047), Clopidogrel loading > 300 mg (p = 0.006) and renal insufficiency (p = 0.04) were independently associated with a higher risk of major bleeding. Bleeding was independently associated with an increased risk of hospital and 30 day incidence of death, MI and stroke (p = 0.03). Patients with major bleeding showed higher frequency of blood transfusion (p = 0.0001), discontinuation of antithrombotics (p = 0.0001), mortality (p = 0.0001), and MI (p = 0.02). Haemoglobin decrease at cut off point of 3.4 gm predicted major complications with sensitivity 91% and specificity 88% with AUC of 0.9 and (p = 0.0001).
Conclusions: Major bleeding is a powerful independent predictor of in-hospital and 30 day mortality in patients with ACS. Advanced age, renal insufficiency, high clopidogrel loading and invasive coronary procedures are independent risk factors for major bleeding in ACS patients.
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