Al-Sallami Hesham, Ferguson Ruth, Wilkins Gerard, Gray Andrew, Medlicott Natalie J
School of Pharmacy, University of Otago, PO Box 913, Dunedin, New Zealand.
N Z Med J. 2008 Nov 7;121(1285):87-95.
To determine the incidence of bleeding associated with the use of enoxaparin in NSTEACS at Dunedin Public Hospital (DPH) and to identify bleeding risk factors in this patient group.
A case-control retrospective review of clinical notes was undertaken. NSTEACS admissions in 2005 where a bleeding event occurred were identified and matched with controls (matched for age and sex). The incidence of Thrombolysis in Myocardial Infarction (TIMI) minor and major bleeding, not related to cardiac surgery, was determined. Univariate and multivariate analyses were used to identify risk factors for all bleeding events.
There were 446 eligible NSTEACS admissions (409 patients), of which 47 bleeding events (10.5%) were reported. Eight events (1.8%) were major according to the TIMI bleeding classification. Three risk factors were identified: renal function, the duration of enoxaparin therapy, and medical conditions involving haemostasis. Renal impairment and the duration of enoxaparin therapy were found to be significant predictors of bleeding (p=0.036 and p=0.008, respectively).
The incidence of bleeding in NSTEACS patients treated with enoxaparin at DPH is comparable to that reported in the literature. Renal impairment and prolonged treatment with enoxaparin were significantly associated with an increase in bleeding risk.
确定达尼丁公立医院（DPH）非ST段抬高型急性冠脉综合征（NSTEACS）患者使用依诺肝素相关出血的发生率，并识别该患者群体的出血风险因素。
对临床记录进行病例对照回顾性研究。确定2005年发生出血事件的NSTEACS入院患者，并与对照组（按年龄和性别匹配）进行匹配。确定与心脏手术无关的心肌梗死溶栓（TIMI）轻微和严重出血的发生率。采用单因素和多因素分析来识别所有出血事件的风险因素。
有446例符合条件的NSTEACS入院患者（409例患者），其中报告了47例出血事件（10.5%）。根据TIMI出血分类，8例事件（1.8%）为严重出血。确定了三个风险因素：肾功能、依诺肝素治疗持续时间以及涉及止血的医疗状况。发现肾功能损害和依诺肝素治疗持续时间是出血的重要预测因素（分别为p=0.036和p=0.008）。
DPH接受依诺肝素治疗的NSTEACS患者的出血发生率与文献报道相当。肾功能损害和依诺肝素的长期治疗与出血风险增加显著相关。
