Withholding antiplatelet therapy from patients with acute coronary syndromes and bleeding increases ischemic risk

摘要

Patients with acute coronary syndromes (ACS) who experience major bleeding during their hospital stay, are often discharged without antiplatelet therapy. A recent retrospective study by investigators from the National University Heart Centre Singapore has demonstrated that this practice increases long-term risk of ischemic events, especially among those who undergo percutaneous coronary intervention (PCI).Mark Y Chan and colleagues examined antiplatelet use among 8582 patients with in-hospital bleeding drawn from 26,451 pooled ACS patients who participated in four randomized trials of antithrombotic therapy: PURSUIT, PARAGON-A, PARAGON-B, and SYNERGY. Outcomes were compared in patients who had been discharged with or without antiplatelet therapy up to 6 months. Of the patients that experienced in-hospital bleeding, 9.6% were discharged without antiplatelet therapy.