{"id":31987,"date":"2012-09-24T16:15:55","date_gmt":"2012-09-24T20:15:55","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=31987"},"modified":"2012-09-24T16:15:55","modified_gmt":"2012-09-24T20:15:55","slug":"dramatic-increase-in-bleeding-accompanies-addition-of-oral-anticoagulant-therapy-in-acs","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/09\/24\/dramatic-increase-in-bleeding-accompanies-addition-of-oral-anticoagulant-therapy-in-acs\/","title":{"rendered":"&#8216;Dramatic&#8217; Increase in Bleeding Accompanies Addition of Oral Anticoagulant Therapy in ACS"},"content":{"rendered":"<p>The newer oral anticoagulants may help reduce ischemic events after an acute coronary syndrome (ACS), but only at the cost of a &#8220;dramatic&#8221; increase in bleeding complications, according to <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1362940\">a new meta-analysis<\/a> published in the <em>Archives of Internal Medicine.<\/em><\/p>\n<p>Hungarian researchers performed a systematic review and meta-analysis of seven trials in which 31,286 ACS patients were randomized to placebo or a new oral anticoagulant, either an anti-Xa or direct thrombin inhibitor. All patients also received antiplatelet therapy. Here are the odds ratios for bleeding events and important clinical endpoints with the newer agents:<\/p>\n<ul>\n<li>TIMI major bleeding events: OR 3.03 (2.20-4.16)<\/li>\n<li>Overall mortality: OR 0.90 (0.76-1.06)<\/li>\n<li>Composite ischemic events: OR 0.86 (0.79-0.94)<\/li>\n<li>Stent thrombosis (definite or probable): OR 0.73 (0.54-0.98)<\/li>\n<\/ul>\n<p>&#8220;These results suggest that the unrestricted use of new-generation oral anticoagulant agents as an adjunct to dual antiplatelet therapy after an ACS cannot be recommended,&#8221; the authors concluded. However, they left open the possibility that the newer oral anticoagulants may be beneficial in the 6%-21% of ACS patients who require long-term anticoagulation for atrial fibrillation and other conditions.<\/p>\n<p>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1362889\">an accompanying comment<\/a>, Adrian Hernandez writes that &#8220;the conclusions of the meta-analysis seem to be robust.&#8221; He points out that the large differences in the relative risk of bleeding and clinical events found in the meta-analysis translate into smaller differences in absolute risk. Nevertheless, he writes, &#8220;the benefit is largely canceled by the harm; therefore,\u00a0the routine use of [novel oral anticoagulants] among patients with ACS is unwarranted.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The newer oral anticoagulants may help reduce ischemic events after an acute coronary syndrome (ACS), but only at the cost of a &#8220;dramatic&#8221; increase in bleeding complications, according to a new meta-analysis published in the Archives of Internal Medicine. Hungarian researchers performed a systematic review and meta-analysis of seven trials in which 31,286 ACS patients [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,1],"tags":[239,311,1154],"class_list":["post-31987","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-general","tag-acs","tag-bleeding","tag-oral-anticoagulants"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31987","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=31987"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31987\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=31987"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=31987"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=31987"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}