Hemorrhage

IJCS

Original Article

Chocolate Consumption Does Not Reduce the Risk of Cardiovascular Events and Increases the Risk of Gastrointestinal Bleeding One Year After the First Myocardial Infarction

Daniel Medeiros Moreira et al. Lara Marcon Dandolini Tammuz Fattah Rodrigo de Moura Joaquim Roberto Leo da Silva

Abstract

Background

Coronary artery disease is the leading cause of death worldwide, with high social and financial costs. Although previous studies have demonstrated the potential of chocolate to reduce coronary events, data on its effects in patients who have suffered an acute myocardial infarction (AMI) are lacking.

Objective

To evaluate the impact of chocolate consumption on the incidence of events in patients with AMI followed for one year.

Methods

A subanalysis of the Catarina Heart study, which evaluated patients hospitalized with a diagnosis of the first AMI, was conducted. During hospitalization, patients were asked about their chocolate consumption before the event. The incidence of events was compared between consumers and non-consumers of chocolate before the AMI. The analyzed outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, reinfarction, stroke, in-stent restenosis, acute stent thrombosis, gastrointestinal bleeding, and bleeding requiring transfusion. Cox regression models were applied, and p < 0.05 was considered statistically significant.

Results

A total of 1404 patients were analyzed, of whom 490 (34.9%) consumed chocolate. Chocolate consumption neither reduced the risk of MACE (hazard ratio [HR] = 0.88 [0.57 – 1.37], p = 0.569) nor showed benefits in other outcomes, such as cardiovascular mortality, reinfarction, or stroke. However, its consumption was significantly associated with an increased risk of gastrointestinal bleeding (HR = 2.89 [1.16 – 7.24], p = 0.023) without increasing the risk of bleeding requiring transfusion or acute stent thrombosis.

Conclusion

Chocolate consumption before AMI did not reduce major cardiovascular events and was associated with an increased risk of gastrointestinal bleeding.

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IJCS

Editorial

Atrial Fibrillation and Hemodialysis – Should we Anticoagulate These Patients? Ischemic Versus Hemorrhagic Risk

Iara Atié Malan

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide, and it is a very frequent cause of increased morbidity and mortality in adults. This arrhythmia favors the formation of thrombi, which can lead to systemic embolism, such as ischemic stroke.

To identify patients with thromboembolic risk, the most used score is the CHA2DS2VASC, which takes the following factors in consideration: heart failure, arterial hypertension, age, diabetes, previous stroke, vascular disease, and sex. It is worth emphasizing that this score does not take renal function or dialysis treatment into consideration.

[…]

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IJCS

Original Article

Hemorrhagic Versus Ischemic Risk in Patients with Atrial Fibrillation on Hemodialysis

Mariana Sousa et al. Gonçalo Cruz Sara Vilela Catarina Cardoso … Pedro Bravo José Paulo Santos Cristina Santos Jorge Silva

Abstract

Background

Hemodialysis (HD) patients with atrial fibrillation (AF) have a particularly high risk of stroke and bleeding, but no high-quality evidence-based recommendations exist to properly manage these patients.

Objectives

We aim to evaluate the ischemic versus the hemorrhagic risk in a HD population with AF.

Methods

We selected incident patients that started hemodialysis between 2011 and 2015. All patients that had AF before HD, or developed AF during the follow-up, were included. Both CHA₂DS₂ -VASC and HAS-BLED scores were calculated at the time of beginning of HD or AF diagnosis and correlated with the outcomes using a logistic regression model. The outcomes were hemorrhagic events, ischemic events and death related to any of these events. A p-value < 0.05 was set as statistically significant.

Results

Forty-six patients were included. Most of them had had AF before they started hemodialysis. Twenty-two patients were on oral anticoagulation (OAC). There was no significant difference between the incidence of ischemic and hemorrhagic events, regardless of the use of OAC. Previous stroke, transient ischemic attack, and thromboembolic event significantly increased the risk of an ischemic event (OR 6.78, p=0.028).

Conclusions

In this population, we did not observe any difference between the incidence of ischemic and hemorrhagic events, which was also true in patients with OAC. Therefore, the benefit of OAC in such patients remains questionable. However, patients with previous stroke, transient ischemic attack, or thromboembolic event seem to have a higher risk of new ischemic events and might benefit from anticoagulation.

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IJCS

Original Article

Predictors of Hospitalization in Vitamin K Antagonist Users Presenting with Bleeding at the Emergency Department

Alan Fabiani Chiaparini et al. Paola Stefania Bohrer Rabaioli João Vitor Slaviero Cinthia Scatolin Tem-Pass … Hugo Antonio Fontana Filho Iran Castro Eduardo Dytz Almeida Tiago Luiz Luz Leiria

Abstract

Background

Vitamin K antagonists (VKA) are indicated for the prevention of thromboembolic events and reduction of mortality in patients with atrial fibrillation and patients with valvular prostheses. However, their use is associated with bleeding complications and hospitalizations. Predictors of hospital admission for bleeding in these patients are poorly known.

Objectives

To define the predictors for hospitalization of VKA users who seek emergency care due to bleeding.

Methods

Single-center, cross-sectional study, with retrospective analysis of electronic medical records from 03/01/2012 to 02/27/2017. Clinical and laboratory variables were compared between patients who were hospitalized and those who were not. A logistic regression model as used, in which the variables were included using the Backward stepwise method, with a p value of 0.05 as the input criterion, a removal value of 0.20 and a confidence interval of 95%. The p-value was considered statistically significant when <0.05.

Results

A total of 510 patients with bleeding were included, of whom 158 were hospitalized. Predictors of hospitalization were: INR at supratherapeutic levels (OR 3.45; P <0.01; 95% CI 1.58 – 7.51), gastrointestinal bleeding (OR 2.36; P <0.01; CI 95% 1.24 – 4.50), drop in hemoglobin (OR 6.93; P <0.01; 95% CI 3.67 – 13.07), heart failure (OR 1.96; P 0.01; 95% CI 1.16 – 3.30) and need for blood transfusion (OR 8.03; P <0.01; 95% CI 2.98 – 21.64).

Conclusion

Drop in hemoglobin, heart failure, INR at supratherapeutic levels, gastrointestinal bleeding and need for blood transfusion were associated with hospitalization. Identification of these factors in the initial evaluation would help to define which patients will demand more intensive care.

Conclusion:

A loading dose of 300 mg or more of clopidogrel.

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