Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK.
The Duke Clinical Research Institute, Durham, North Carolina, USA.
BMJ Open. 2019 Feb 20;9(2):e023337. doi: 10.1136/bmjopen-2018-023337.
The primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting.
A narrative systematic review.
Medline, Embase, Amed and Central (Cochrane) were searched up to August 2018.
For the primary objective, randomised controlled trials (RCT) and observational studies reporting on the incidence of bleeding post hospital discharge were included. For the secondary objective, RCTs and observational studies that compared patients with bleeding versus those without bleeding post hospital discharge vis-à-vis mortality, MACE, myocardial re-infarction and rehospitalisation were included.
53 studies (36 observational studies and 17 RCTs) with a combined cohort of 714 458 participants for the primary objectives and 187 317 for the secondary objectives were included. Follow-up ranged from 1 month to just over 4 years. The incidence of bleeding within 12 months post hospital discharge ranged from 0.20% to 37.5% in observational studies and between 0.96% and 39.4% in RCTs. The majority of bleeds occurred in the initial 3 months after hospital discharge with bruising the most commonly reported event. Major bleeding increased the risk of mortality by nearly threefold in two studies. One study showed an increased risk of MACE (HR 3.00,95% CI 2.75 to 3.27; p<0.0001) with bleeding and another study showed a non-significant association with rehospitalisation (HR 1.20,95% CI 0.95 to 1.52; p=0.13).
Bleeding complications following ACS management are common and continue to occur in the long term after hospital discharge. These bleeding complications may increase the risk of mortality and MACE, but greater evidence is needed to assess their long-term effects.
CRD42017062378.
本研究的主要目的是确定急性冠脉综合征（ACS）患者出院后的出血事件发生率。次要目的是确定出血对出院后患者死亡率、主要不良心血管事件（MACE）、心肌再梗死和再住院的预后影响。
叙述性系统评价。
截至 2018 年 8 月，检索了 Medline、Embase、Amed 和中央（Cochrane）数据库。
主要目的纳入了报告出院后出血发生率的随机对照试验（RCT）和观察性研究；次要目的纳入了比较出院后出血患者与非出血患者死亡率、MACE、心肌再梗死和再住院率的 RCT 和观察性研究。
共纳入了 53 项研究（36 项观察性研究和 17 项 RCT），主要目的的综合队列包含了 714458 例患者，次要目的包含了 187317 例患者。随访时间从 1 个月到 4 年多不等。出院后 12 个月内出血的发生率在观察性研究中为 0.20%至 37.5%，在 RCT 中为 0.96%至 39.4%。大多数出血发生在出院后最初 3 个月内，最常见的报告事件为瘀伤。两项研究显示，大出血使死亡率增加近两倍。一项研究显示，出血与 MACE 风险增加相关（HR 3.00，95%CI 2.75 至 3.27；p<0.0001），另一项研究显示与再住院率无显著关联（HR 1.20，95%CI 0.95 至 1.52；p=0.13）。
ACS 治疗后出血并发症很常见，且在出院后长期仍持续发生。这些出血并发症可能增加死亡率和 MACE 的风险，但需要更多证据来评估其长期影响。
PROSPERO 注册号：CRD42017062378。
