Incidence and type of bleeding complications early and late after acute coronary syndrome admission in a New Zealand cohort (ANZACS-QI-7).

AIMS

Use of anti-thrombotic agents has reduced ischaemic events in acute coronary syndromes (ACS), but can increase the risk of bleeding. Identifying bleeding events using a consistent methodology from routinely collected national datasets would be useful. Our aims were to describe the incidence and types of bleeding in-hospital and post-discharge in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) cohort.

METHODS

3,666 consecutive patients admitted with ACS (2007-2010) were identified within the ANZACS-QI registry. A set of International Classification of Disease 10 (ICD-10) codes that identified bleeding events was developed. Anonymised linkage to national mortality and hospitalisation datasets was used to identify these bleeding events at the index admission and post-discharge.

RESULTS

Three hundred and ninety-nine (10.8%) out of 3,666 patients had at least one bleeding event during a mean follow-up of 1.94 years. One hundred and sixty-one (4.4%) had a bleeding event during their index admission, and 271 (7.4%) patients were re-hospitalised with bleeding during follow-up. Sixty-one patients (37.9%) were transfused for bleeding in the index admission cohort, and 59 patients (21.8%) at a subsequent admission. Procedural bleeding was the most common event during the index admission, whereas gastrointestinal bleeding was the most common delayed bleeding presentation.

CONCLUSION

One in ten ACS patients experienced a significant bleeding event within 2 years. The use of this ICD-10 bleeding definition in national ACS cohorts will facilitate the study of bleeding event incidence and type over time and between geographical regions, both nationally and internationally, and the impact of changes in anti-thrombotic therapy and interventional practice.