Manoukian Steven V
Sarah Cannon Research Institute, 3322 West End Avenue, Nashville, TN 37203, USA.
J Invasive Cardiol. 2010 Mar;22(3):132-41.
Antithrombotic therapy, including antiplatelet and antithrombin agents, effectively reduces the risk of ischemic events in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI). Unfortunately, these agents intrinsically increase the risk of bleeding complications, which in turn are associated with adverse outcomes, particularly mortality. Accordingly, there is great value in improving the understanding of bleeding complications, including the definitions employed, severity and types of bleeding, as well as the patient characteristics, clinical presentations, and treatment variables that are associated with an increased risk of bleeding. The ultimate goal is to optimize patient outcomes by employing pharmacological and nonpharmacological strategies that minimize bleeding risk while maintaining efficacy. The objective of this article is to present the criteria by which bleeding is expressed and discuss the correlation between bleeding and adverse outcomes, as well as the relative impact of bleeding compared with ischemic events such as myocardial infarction on mortality. Furthermore, the relationship between bleeding and modifications of long-term treatment and methods to predict and prevent bleeding will be explored.
抗栓治疗，包括抗血小板和抗凝血酶药物，可有效降低急性冠状动脉综合征（ACS）患者和接受经皮冠状动脉介入治疗（PCI）患者发生缺血事件的风险。不幸的是，这些药物本身会增加出血并发症的风险，而出血并发症又与不良后果相关，尤其是死亡率。因此，深入了解出血并发症具有重要价值，包括所采用的定义、出血的严重程度和类型，以及与出血风险增加相关的患者特征、临床表现和治疗变量。最终目标是通过采用药理学和非药理学策略来优化患者预后，这些策略在保持疗效的同时尽量降低出血风险。本文的目的是介绍出血的表达标准，讨论出血与不良后果之间的相关性，以及出血与心肌梗死等缺血事件相比对死亡率的相对影响。此外，还将探讨出血与长期治疗调整之间的关系以及预测和预防出血的方法。
