Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 48

In the context of ACS or PCI, the occurrence of major bleeding has at least the same prognostic impact as the occurrence of a new MI.^141,142 Compared with patients without bleeding, patients who experience bleeding have a much higher in-hospital but also late mortality (up to 5× higher). In fact, while bleeding is rarely fatal by itself, bleeding strikingly increases the risk of MI, coronary thrombosis, and ischemic events through the following concepts: (i) antithrombotic therapy may need to be temporarily withheld; (ii) bleeding is a very potent activator of the coagulation cascade; (iii) acute anemia may lead to demand ischemia; (iv) blood transfusion, sometimes necessary, leads to untoward proinflammatory and prothrombotic effects. One-half to two-thirds of major bleeding events are femoral access site bleeds, while the remaining events are gastrointestinal or genitourinary bleeds, a drop in hemoglobin without an overt source, or, rarely but fatally, an intracranial bleed.

Radial access drastically reduces bleeding and is associated with improved outcomes when performed by experienced operators. Appropriate antithrombotic therapy, with a limited use of GPI, reduces access and non-access bleeding and improve short- but also long-term outcomes.