Key result
Risk stratification during the diagnosis of acute coronary syndrome is crucial for selecting appropriate therapy, as patients at high risk of ischemic events are also at high risk of bleeding complications.
Why the study?
Acute coronary syndrome requires risk stratification to guide treatment decisions, but overlapping ischemic and bleeding risks complicate management strategies.
Acute coronary syndrome (ACS) represent a life-threatening manifestation of atherosclerosis usually precipitated by acute thrombosis, induced by ruptured or eroded atherosclerotic plaque. Data suggest that the annual incidence of NSTE-ACS is higher than that of STEMI but with comparable mortality rate after 6 months. During the process of establishing diagnosis of ACS and excluding differential diagnoses, parallel process is risk stratification. An estimation of risk is useful in selection of the site of care, selection of therapy, especially platelet glycoprotein IIb/IIIa inhibitors and coronary revascularization. The high-risk patients are candidates for more aggressive antithrombotic therapy and invasive strategy. The most frequent nonischaemic complications are bleeding complications. Several definitions, including clinical aspects of bleeding (location and impact on haemodynamics) and/or need for blood transfusion as well as magnitude of haemoglobin drop, are used to grade bleeding severity. The CRUSADE bleeding score quantifies risk for in-hospital major bleeding across all post-admission treatments, which enhances baseline risk assessment for NSTEMI care. The risk factors for bleeding and ischaemic events overlap considerably, with the result that patients at high risk of ishaemic events are also at high risk of bleeding complication.
No takes yet. Share an insight, caveat, or question.
Šalinger-Martinović et al. (2014) conducted a review in Acute coronary syndrome. Risk stratification was evaluated. Risk stratification during the diagnosis of acute coronary syndrome is crucial for selecting appropriate therapy, as patients at high risk of ischemic events are also at high risk of bleeding complications.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: