Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review.
acute coronary syndrome
bleeding
haemorrhage
mortality
outpatient
post discharge
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
20 02 2019
20 02 2019
Historique:
entrez:
22
2
2019
pubmed:
23
2
2019
medline:
4
3
2020
Statut:
epublish
Résumé
The primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting. A narrative systematic review. Medline, Embase, Amed and Central (Cochrane) were searched up to August 2018. For the primary objective, randomised controlled trials (RCT) and observational studies reporting on the incidence of bleeding post hospital discharge were included. For the secondary objective, RCTs and observational studies that compared patients with bleeding versus those without bleeding post hospital discharge vis-à-vis mortality, MACE, myocardial re-infarction and rehospitalisation were included. 53 studies (36 observational studies and 17 RCTs) with a combined cohort of 714 458 participants for the primary objectives and 187 317 for the secondary objectives were included. Follow-up ranged from 1 month to just over 4 years. The incidence of bleeding within 12 months post hospital discharge ranged from 0.20% to 37.5% in observational studies and between 0.96% and 39.4% in RCTs. The majority of bleeds occurred in the initial 3 months after hospital discharge with bruising the most commonly reported event. Major bleeding increased the risk of mortality by nearly threefold in two studies. One study showed an increased risk of MACE (HR 3.00,95% CI 2.75 to 3.27; p<0.0001) with bleeding and another study showed a non-significant association with rehospitalisation (HR 1.20,95% CI 0.95 to 1.52; p=0.13). Bleeding complications following ACS management are common and continue to occur in the long term after hospital discharge. These bleeding complications may increase the risk of mortality and MACE, but greater evidence is needed to assess their long-term effects. CRD42017062378.
Identifiants
pubmed: 30787079
pii: bmjopen-2018-023337
doi: 10.1136/bmjopen-2018-023337
pmc: PMC6398751
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e023337Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Circ Cardiovasc Interv. 2010 Apr;3(2):140-7
pubmed: 20332382
Am J Cardiol. 2003 Oct 15;92(8):930-5
pubmed: 14556868
Int J Cardiol. 2018 Mar 1;254:10-15
pubmed: 29407077
World J Cardiol. 2013 Jun 26;5(6):196-206
pubmed: 23802048
Eur Heart J. 2009 Apr;30(8):900-7
pubmed: 18819961
JACC Cardiovasc Interv. 2016 Jul 25;9(14):1450-7
pubmed: 27372190
Circulation. 2009 Apr 14;119(14):1873-82
pubmed: 19332461
N Engl J Med. 2006 Apr 6;354(14):1464-76
pubmed: 16537663
J Am Coll Cardiol. 2007 Oct 30;50(18):1742-51
pubmed: 17964037
J Am Coll Cardiol. 2016 Jan 5;67(1):59-65
pubmed: 26764067
J Am Coll Cardiol. 2007 Mar 27;49(12):1362-8
pubmed: 17394970
Circ Cardiovasc Interv. 2009 Jun;2(3):222-9
pubmed: 20031719
J Am Coll Cardiol. 2009 Jun 2;53(22):2019-27
pubmed: 19477350
Eur Heart J. 2017 Mar 14;38(11):804-810
pubmed: 28363222
Turk Kardiyol Dern Ars. 2018 Apr;46(3):175-183
pubmed: 29664423
N Z Med J. 2016 Jul 01;129(1437):27-38
pubmed: 27362596
Eur Heart J. 2018 Jan 7;39(2):119-177
pubmed: 28886621
Eur Heart J. 2007 May;28(10):1193-204
pubmed: 17456480
Open Heart. 2016 Oct 31;3(2):e000460
pubmed: 27843564
J Am Coll Cardiol. 2010 Jun 8;55(23):2556-66
pubmed: 20513595
Am J Cardiol. 2014 Mar 15;113(6):936-44
pubmed: 24444781
J Am Coll Cardiol. 2015 May 26;65(20):2211-21
pubmed: 25787199
Lancet. 2009 Dec 12;374(9706):1967-74
pubmed: 20006130
JACC Cardiovasc Interv. 2012 Sep;5(9):906-16
pubmed: 22995877
Circulation. 2010 Nov 2;122(18 Suppl 3):S787-817
pubmed: 20956226
Eur Heart J. 2015 May 21;36(20):1242-51
pubmed: 25718355
J Gastroenterol. 2011 Jan;46(1):39-45
pubmed: 20811753
Eur Heart J. 2017 Nov 1;38(41):3070-3078
pubmed: 28510646
Am J Cardiol. 2013 Jan 1;111(1):38-44
pubmed: 23040597
Am J Cardiovasc Drugs. 2018 Apr;18(2):129-141
pubmed: 29222628
Arch Cardiovasc Dis. 2016 Jan;109(1):31-8
pubmed: 26514325
J Dig Dis. 2014 Apr;15(4):195-201
pubmed: 24373542
Am Heart J. 2012 Apr;163(4):720-8
pubmed: 22520540
EuroIntervention. 2009 Aug;5(3):325-9
pubmed: 19736156
Am J Cardiol. 2015 Apr 15;115(8):1042-8
pubmed: 25726381
Neth Heart J. 2018 Aug;26(7-8):393-400
pubmed: 29931649
Br J Clin Pharmacol. 2017 Sep;83(9):2056-2065
pubmed: 28345154
Eur Heart J. 2011 Oct;32(19):2376-86
pubmed: 21875855
J Am Heart Assoc. 2016 Sep 09;5(9):
pubmed: 27613773
Eur Heart J. 2012 Oct;33(20):2569-619
pubmed: 22922416
Thromb Haemost. 2018 May;118(5):929-938
pubmed: 29614517
Circulation. 2007 Dec 11;116(24):2793-801
pubmed: 18025530
J Am Heart Assoc. 2015 Dec 11;4(12):
pubmed: 26656860
Lancet. 2017 Mar 11;389(10073):1025-1034
pubmed: 28290994
Circulation. 2006 Aug 22;114(8):774-82
pubmed: 16908769
JAMA. 2015 Feb 24;313(8):805-14
pubmed: 25710657
Arch Intern Med. 2005 Apr 11;165(7):784-9
pubmed: 15824298
Circ Cardiovasc Interv. 2015 Apr;8(4):
pubmed: 25825007
Am Heart J. 2006 May;151(5):976.e1-6
pubmed: 16644315
Am Heart J. 2015 Jan;169(1):78-85.e4
pubmed: 25497251
J Thromb Thrombolysis. 2010 Nov;30(4):434-40
pubmed: 20213257
BMJ Open. 2015 Dec 15;5(12):e007786
pubmed: 26671947
Thromb Res. 2015 Jan;135(1):26-30
pubmed: 25467434
JAMA. 2015 Apr 7;313(13):1336-46
pubmed: 25775052
Can J Cardiol. 2013 Sep;29(9):1097-103
pubmed: 23462375
Am Heart J. 2016 Oct;180:82-9
pubmed: 27659886
Eur Heart J. 2011 Dec;32(23):2999-3054
pubmed: 21873419
Postgrad Med J. 2006 Mar;82(965):224-7
pubmed: 16517807
Circulation. 2014 Dec 23;130(25):e344-426
pubmed: 25249585
JACC Cardiovasc Interv. 2014 Oct;7(10):1117-27
pubmed: 25240538
J Am Coll Cardiol. 2013 May 28;61(21):2130-8
pubmed: 23541975
Arch Cardiovasc Dis. 2016 May;109(5):337-47
pubmed: 27079469
J Am Coll Cardiol. 2015 Apr 14;65(14):1411-20
pubmed: 25857906
J Am Coll Cardiol. 2014 Jan 28;63(3):225-32
pubmed: 24140678
J Am Coll Cardiol. 2013 Sep 10;62(11):981-9
pubmed: 23747760
PLoS One. 2016 Aug 04;11(8):e0160046
pubmed: 27490468
Lancet. 1994 Feb 26;343(8896):499-503
pubmed: 7906757
Am J Cardiol. 2011 Apr 15;107(8):1136-43
pubmed: 21324428
Rev Esp Cardiol (Engl Ed). 2019 Mar;72(3):215-223
pubmed: 30029980
N Engl J Med. 2015 May 7;372(19):1791-800
pubmed: 25773268
Rev Esp Cardiol (Engl Ed). 2018 Oct;71(10):829-836
pubmed: 29656987
Am J Cardiol. 2005 May 15;95(10):1218-22
pubmed: 15877994
Heart. 2015 Sep;101(18):1475-84
pubmed: 26109589
Can J Cardiol. 2017 Aug;33(8):998-1005
pubmed: 28669702
Circ Cardiovasc Interv. 2015 Apr;8(4):
pubmed: 25858976
Open Heart. 2014 Feb 13;1(1):e000021
pubmed: 25332786
Kidney Int. 2017 Jan;91(1):216-226
pubmed: 27865441
Am J Cardiol. 2005 Nov 1;96(9):1200-6
pubmed: 16253582
Heart. 2017 Aug;103(15):1168-1176
pubmed: 28381584
JAMA. 2016 Apr 26;315(16):1735-49
pubmed: 27022822
J Clin Epidemiol. 2010 May;63(5):513-23
pubmed: 19595577
Rev Esp Cardiol (Engl Ed). 2016 May;69(5):527-9
pubmed: 27025302