Cardiology Department, Central Defense Hospital, Alcalá University, Madrid, Spain.
Cardiology Department, Central Defense Hospital, Alcalá University, Madrid, Spain.
Am J Cardiol. 2020 Apr 15;125(8):1142-1147. doi: 10.1016/j.amjcard.2020.01.010. Epub 2020 Feb 19.
Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies.
出血风险分层是老年人尚未解决的问题。贫血可能反映亚临床失血，在经皮冠状动脉介入治疗后可能会加重。我们旨在前瞻性确定贫血对 448 例年龄在 75 岁或以上、接受经皮冠状动脉介入治疗且无口服抗凝治疗适应证的患者出血风险的影响。我们评估了世界卫生组织定义的贫血对 1 年非穿刺部位相关大出血发生率的影响。贫血的患病率为 39%，贫血患者中有 13.1%和非贫血患者中有 5.2%发生出血事件（风险比 2.75，95%置信区间 1.37 至 5.54，p=0.004）。PRECISE-DAPT 和 CRUSADE 评分均不如血红蛋白对出血的预测准确。总之，贫血是出血的有力预测指标，可能有助于简化治疗方案。
