Bleeding complications are best classified by use of the BARC (Bleeding Academic Research Consortium) classification. As severe (but not only) bleeding events have an impact on clinical outcome all health professionals (in the specialties concerned) should know the mechanism of action, effects and interactions of antithrombotic therapies. Major bleeding under vitamin K antagonists (VKA) is associated with 30% mortality, which increases to 50-70% if intracerebral haemorrhage takes place. A switch from VKA to the new (or direct) oral anticoagulants (NOACs or DOACs), if possible, has significantly reduced bleeding hazards including also ICH. An additional benefit for NOACs is the availability of antidotes, which exhibit a much faster action as the moderate effect of vitamin K or other compounds against VKA-induced bleedings.
Moreover, bleeding hazards increase with the indication for a combination of more antithrombotic agents (TAT) e.g. in triple antithrombotic therapy when an oral anticoagulant is combined with two antiplatelet agents but also with the prolongation of antithrombotic strategies.
Accordingly, recent data have shown a significant decrease in bleeding hazards when TAT is performed for maximal 1 month followed by a dual antithrombotic therapy (DAT, 1 OAC and 1 antiplatelet agent) or if a dual antithrombotic strategy is offered form the beginning in patients with atrial fibrillation after stent implantation.
Finally, the development and clinical investigation of new anticoagulants with a still lower bleeding event rate are ongoing.
Prof. Kurt Huber
Interventional cardiologist, Vienna, Austria
Resources have been selected by Dr. Edina Cenko
Young ACVC Member
Department of Experimental, Diagnostic and Specialty Medicine (DIMES) |University of Bologna, Italy
Intensive and Acute Cardiac Care Textbook - Online
Acute Cardiovascular Care Congress Resources
A selection of resources from Acute Cardiovascular Care 2019:
- Dual or triple antithrombotic therapy?
- Prolonged DAPT after acute coronary syndrome: individualise!
- Challenging situations: from kidney disease to triple therapy
- Secondary Prevention after ACS- section: Antithrombotic treatment - P. 41
- Drugs in Acute Cardiovascular Care - P. 121
- The trial of the trials: AUGUSTUS vs ENTRUST AF PCI: from trial design to clinical implications
- Anticoagulation patterns in the acute phase of NSTEMI
- How to individualise DAPT duration after an acute coronary syndrome
Scientific Papers from the EHJ-ACVC
- Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association
- Non-ST elevation acute coronary syndromes: timing and selection of early invasive management, ECG monitoring need, DAPT duration, pathogenesis of recurrence and beware of delirium in the intensive/acute cardiac care unit!
- Impact of known or new-onset atrial fibrillation on 2-year cardiovascular event rate in patients with acute coronary syndromes: results from the prospective EPICOR Registry
- Edoxaban in atrial fibrillation patients with established coronary artery disease: Insights from ENGAGE AF–TIMI 48.
- Safety and efficacy of rivaroxaban for the secondary prevention following acute coronary syndromes among biomarker-positive patients: Insights from the ATLAS ACS 2-TIMI 51 trial.
- The efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and coronary artery disease: A meta-analysis of randomized trials.
ACVC Scientific Poster
- Quality Indicators - Definition & Assessment