New Antithrombotic Drugs in Acute Coronary Syndromes: ??he Role of Fondaparinux and Bivalirudin in Reducing Major Hemorrhages and Mortality

Abstract

The net clinical benefit of any antithrombotic drug for the treatment of acute coronary syndromes (ACS) is described by its favorable effects on major outcomes (mortality, reinfarction, stroke) and its unfavorable effects on bleeding. Traditionally, with most antithrombotic therapies an increased hemorrhagic risk is accepted in order to achieve better efficacy. Recently, the importance of bleeding as an adverse outcome has received wide attention. Major bleeding in ACS is not rare. In GRACE, the multinational registry of ACS, 4% of patients with unstable angina, STEMI or non-STEMI had a major hemorrhage.In-hospital mortality was 18.6% in those patients who experienced major bleeding versus only 5.1% in those without such an adverse event. What is more interesting is the fact that the appearance of a non-fatal major bleeding event in hospital increases the long-term risk of death and carries a similar prognostic significance to re-infarction. The odds ratio (OR) for 6-month mortality is 5.6 for a patient with re-infarction in hospital and 4.5 for a patient with major hemorrhage in hospital