Blødningskomplikationer ved behandling med clopidogrel og acetylsalicylsyre efter akut koronart syndrom

Janus Kjær, Christian Hastrup Larsen, Tina Svenstrup Poulsen, Jacob E. Møller, Hans Mickley

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

INTRODUCTION: The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study showed that patients with unstable angina pectoris (UAP) and non-ST-elevation myocardial infarction (NSTEMI) benefit from combined therapy with acetylsalicylic acid (ASA) and clopidogrel. However, only patients entering clinical randomized trials were studied. We sought to assess whether the risk of bleeding increased after the introduction of the CURE criteria in an unselected population of Danish patients with NSTEMI or UAP. MATERIALS AND METHODS: The CURE criteria were implemented in the Department of Cardiology, Odense University Hospital, in December 2001. Two consecutive one-year periods were studied: period 1, December 2000-November 2001, and period 2, December 2001-November 2002. Patient charts were reviewed, and major bleeding complications and the primary clinical end point (non-fatal myocardial infarction, stroke or death) was registered. Follow-up took place one year later. RESULTS: In all, 290 patients were included in period 1 and 189 in period 2. During period 1, there were 12 (4.1%) and during period 2, 21 (11.1%) major bleeding events (odds ratio 3.07; 95% CI 1.42-6.65; p = 0.005). Compared with the patients treated with clopidogrel and ASA in the CURE study, we also found a three times greater risk of major bleeding in period 2. In particular, patients over 70 years of age and patients undergoing bypass surgery were at heightened risk. The incidence of the primary clinical end point was higher in both period 1 and period 2 than in the CURE study. CONCLUSION: Our study demonstrates an increased risk of major bleeding in unselected patients receiving combination therapy with ASA and clopidogrel after UAP or NSTEMI. Major bleeding complications most frequently occur in patients above 70 years of age and following bypass surgery.

Udgivelsesdato: 2006-Sep-18
OriginalsprogDansk
TidsskriftUgeskrift for læger
Vol/bind168
Udgave nummer38
Sider (fra-til)3209-3214
ISSN0041-5782
StatusUdgivet - 2006

Citer dette

Kjær, Janus ; Larsen, Christian Hastrup ; Poulsen, Tina Svenstrup ; Møller, Jacob E. ; Mickley, Hans. / Blødningskomplikationer ved behandling med clopidogrel og acetylsalicylsyre efter akut koronart syndrom. I: Ugeskrift for læger. 2006 ; Bind 168, Nr. 38. s. 3209-3214.
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title = "Bl{\o}dningskomplikationer ved behandling med clopidogrel og acetylsalicylsyre efter akut koronart syndrom",
abstract = "INTRODUCTION: The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study showed that patients with unstable angina pectoris (UAP) and non-ST-elevation myocardial infarction (NSTEMI) benefit from combined therapy with acetylsalicylic acid (ASA) and clopidogrel. However, only patients entering clinical randomized trials were studied. We sought to assess whether the risk of bleeding increased after the introduction of the CURE criteria in an unselected population of Danish patients with NSTEMI or UAP. MATERIALS AND METHODS: The CURE criteria were implemented in the Department of Cardiology, Odense University Hospital, in December 2001. Two consecutive one-year periods were studied: period 1, December 2000-November 2001, and period 2, December 2001-November 2002. Patient charts were reviewed, and major bleeding complications and the primary clinical end point (non-fatal myocardial infarction, stroke or death) was registered. Follow-up took place one year later. RESULTS: In all, 290 patients were included in period 1 and 189 in period 2. During period 1, there were 12 (4.1{\%}) and during period 2, 21 (11.1{\%}) major bleeding events (odds ratio 3.07; 95{\%} CI 1.42-6.65; p = 0.005). Compared with the patients treated with clopidogrel and ASA in the CURE study, we also found a three times greater risk of major bleeding in period 2. In particular, patients over 70 years of age and patients undergoing bypass surgery were at heightened risk. The incidence of the primary clinical end point was higher in both period 1 and period 2 than in the CURE study. CONCLUSION: Our study demonstrates an increased risk of major bleeding in unselected patients receiving combination therapy with ASA and clopidogrel after UAP or NSTEMI. Major bleeding complications most frequently occur in patients above 70 years of age and following bypass surgery. Udgivelsesdato: 2006-Sep-18",
author = "Janus Kj{\ae}r and Larsen, {Christian Hastrup} and Poulsen, {Tina Svenstrup} and M{\o}ller, {Jacob E.} and Hans Mickley",
year = "2006",
language = "Dansk",
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Blødningskomplikationer ved behandling med clopidogrel og acetylsalicylsyre efter akut koronart syndrom. / Kjær, Janus; Larsen, Christian Hastrup; Poulsen, Tina Svenstrup; Møller, Jacob E.; Mickley, Hans.

I: Ugeskrift for læger, Bind 168, Nr. 38, 2006, s. 3209-3214.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Blødningskomplikationer ved behandling med clopidogrel og acetylsalicylsyre efter akut koronart syndrom

AU - Kjær, Janus

AU - Larsen, Christian Hastrup

AU - Poulsen, Tina Svenstrup

AU - Møller, Jacob E.

AU - Mickley, Hans

PY - 2006

Y1 - 2006

N2 - INTRODUCTION: The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study showed that patients with unstable angina pectoris (UAP) and non-ST-elevation myocardial infarction (NSTEMI) benefit from combined therapy with acetylsalicylic acid (ASA) and clopidogrel. However, only patients entering clinical randomized trials were studied. We sought to assess whether the risk of bleeding increased after the introduction of the CURE criteria in an unselected population of Danish patients with NSTEMI or UAP. MATERIALS AND METHODS: The CURE criteria were implemented in the Department of Cardiology, Odense University Hospital, in December 2001. Two consecutive one-year periods were studied: period 1, December 2000-November 2001, and period 2, December 2001-November 2002. Patient charts were reviewed, and major bleeding complications and the primary clinical end point (non-fatal myocardial infarction, stroke or death) was registered. Follow-up took place one year later. RESULTS: In all, 290 patients were included in period 1 and 189 in period 2. During period 1, there were 12 (4.1%) and during period 2, 21 (11.1%) major bleeding events (odds ratio 3.07; 95% CI 1.42-6.65; p = 0.005). Compared with the patients treated with clopidogrel and ASA in the CURE study, we also found a three times greater risk of major bleeding in period 2. In particular, patients over 70 years of age and patients undergoing bypass surgery were at heightened risk. The incidence of the primary clinical end point was higher in both period 1 and period 2 than in the CURE study. CONCLUSION: Our study demonstrates an increased risk of major bleeding in unselected patients receiving combination therapy with ASA and clopidogrel after UAP or NSTEMI. Major bleeding complications most frequently occur in patients above 70 years of age and following bypass surgery. Udgivelsesdato: 2006-Sep-18

AB - INTRODUCTION: The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study showed that patients with unstable angina pectoris (UAP) and non-ST-elevation myocardial infarction (NSTEMI) benefit from combined therapy with acetylsalicylic acid (ASA) and clopidogrel. However, only patients entering clinical randomized trials were studied. We sought to assess whether the risk of bleeding increased after the introduction of the CURE criteria in an unselected population of Danish patients with NSTEMI or UAP. MATERIALS AND METHODS: The CURE criteria were implemented in the Department of Cardiology, Odense University Hospital, in December 2001. Two consecutive one-year periods were studied: period 1, December 2000-November 2001, and period 2, December 2001-November 2002. Patient charts were reviewed, and major bleeding complications and the primary clinical end point (non-fatal myocardial infarction, stroke or death) was registered. Follow-up took place one year later. RESULTS: In all, 290 patients were included in period 1 and 189 in period 2. During period 1, there were 12 (4.1%) and during period 2, 21 (11.1%) major bleeding events (odds ratio 3.07; 95% CI 1.42-6.65; p = 0.005). Compared with the patients treated with clopidogrel and ASA in the CURE study, we also found a three times greater risk of major bleeding in period 2. In particular, patients over 70 years of age and patients undergoing bypass surgery were at heightened risk. The incidence of the primary clinical end point was higher in both period 1 and period 2 than in the CURE study. CONCLUSION: Our study demonstrates an increased risk of major bleeding in unselected patients receiving combination therapy with ASA and clopidogrel after UAP or NSTEMI. Major bleeding complications most frequently occur in patients above 70 years of age and following bypass surgery. Udgivelsesdato: 2006-Sep-18

M3 - Tidsskriftartikel

VL - 168

SP - 3209

EP - 3214

JO - Ugeskrift for Laeger

JF - Ugeskrift for Laeger

SN - 0041-5782

IS - 38

ER -