Unstable angina / non ST elevation myocardial infarction complications of bleeding and transfusion recommendations


 * ; ; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Recommendations

 * Variability in bleeding definitions across clinical trials makes it difficult to compare the risks of different therapies; however, it is evident that there is an association between bleeding and blood transfusion and an increased risk of adverse events including death, MI, and stroke.
 * Patients at high risk for bleeding complications, such as the elderly, females, and those with renal dysfunction should be identified as requiring strategies to minimize bleeding risk.
 * When an invasive strategy is employed, consideration should be given to the use of the radial artery approach.
 * Prudent dosing of antithrombotic therapy and antiplatelet therapies is essential.
 * Consideration of agents such as bivalirudin and fondaparinux, which have been shown to reduce ischemic complications while simultaneously reducing bleeding risk for a NSTEMI/unstable angina management scheme seems reasonable.