Tuesday, April 28, 2009

New tool to help assess bleeding risks for certain heart attack patients
By Kelly Winget, DCRI Communications

Cardiologists treating heart attack patients want to prevent future blood clots from forming that could block the flow of blood, but the treatments can often increase the risk for serious bleeding. The treatments typically involve strong anti-blood clot medications and inserting catheters to widen blocked arteries.

DCRI researchers were involved in developing a tool that helps clinicians better estimate a patient's risk for major bleeding events while still in the hospital, based on eight predictors. The DCRI's Karen Alexander, MD, was the senior author.

The results appear in the April 14 issue of Circulation.

Researchers used data from the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Quality Improvement Initiative. The risk assessment tool looks at all treatments once a patient is admitted to a hospital due to a heart attack.

The tool is specific to NSTEMI (non-ST-segment-elevation myocardial infarction) patients. This type of heart attack does not cause changes that are detectable by an ECG and a blood test is needed to determine that the heart attack damaged the heart.

The American College of Cardiology/American Heart Association have recently placed greater emphasis on assessing a patient's risk of bleeding when determining the best treatments to use for these patients.

Researchers found that patients at greater risk for major bleeding were older, had lower systolic blood pressure, and had faster heart rates. The patients who experienced major bleeding were also more likely to have in-hospital heart failure and had a higher risk of death than patients who did not have a major bleeding complication.

Researchers also learned that patients who received at least two anti-blood clot medications had an increased risk of bleeding complications, and that having an invasive procedure such as having stents implanted increased the risk of major bleeding.

This tool is unique because it considers baseline characteristics as well as laboratory data. The tool evaluates risk based on gender, history of diabetes or vascular disease, heart rate, systolic blood pressure, signs of congestive heart failure, among others.

Clinical trials have suggested that reducing the risk of bleeding complications can improve a patient's survival rate.

Others from the DCRI involved with developing the risk assessment tool include Anita Chen, MS; Sunil Rao, MD; Kristin Newby, MD, MHS; Tracy Wang, MD, MS; Magnus Ohman, MD; Matthew Roe, MD, MHS, and Eric Peterson, MD, MPH.

Click here for the full article.