4/9/2023 0 Comments Timi major bleedingIt includes a technical center open 24/7, which offers coronary angiography, extracorporeal life support (ECLS), and cardiac surgery services. This university hospital is the regional reference center for the management of patients with ACS and/or cardiogenic shock. We conducted a retrospective observational study in a 23-bed medical-surgical adult ICU in a French university hospital. The primary objective of this study was to compare the bleeding risk of ticagrelor and clopidogrel in ICU patients diagnosed with ACS. To our knowledge, no study to date has examined the risk of bleeding in Intensive Care Unit (ICU) patients with ACS treated with ticagrelor. In fact, intensive care management of critically ill ACS patients often requires invasive techniques that can cause bleeding (central venous catheter, arterial catheter, mechanical ventilation, renal replacement therapy, circulatory assistance, etc.). cardiogenic shock) reported in the literature is significant, ranging from 1 to 12%. This is an important issue given that the percentage of ACS patients with Killip class IV ( i. The most severe cases of ACS require intensive care management, especially in the presence of shock and/or severe respiratory distress. For several years now, ticagrelor has been recommended over clopidogrel in the absence of contraindications, due to greater efficacy and speed of action, even though an increased risk of bleeding has been reported in several cardiology studies. In addition to emergency coronary revascularization via percutaneous coronary intervention (PCI) or cardiac surgery, treatment of acute coronary syndrome (ACS) includes dual antiplatelet therapy in which aspirin is combined with a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor). 29.8% in the ticagrelor group, p = 0.08). No significant difference in ICU mortality was found between the two groups (45.6% in the clopidogrel group vs. The relative risk of bleeding occurrence during ICU stay was 2.60 (confidence interval 95%: 1.55–4.35) for ticagrelor compared to clopidogrel. This significant association was found for both TIMI major bleeding (12.3% vs. Bleeding during ICU stay occurred in 12 patients (21.1%) treated with clopidogrel and in 35 patients (61.4%) treated with ticagrelor ( p<0.0001). Median (first-third quartile) Simplified Acute Physiology Score II was 61.5 (41.0–85.0). According to propensity score matching, 57 patients treated with aspirin and ticagrelor were matched with 57 patients treated with aspirin and clopidogrel. A total of 155 patients were included in the study. Bleeding during ICU stay was defined as all Thrombolysis in myocardial infarction (TIMI) major or minor events. All patients with ACS hospitalized in the ICU of a French university hospital between January 2013 and January 2017 were included in the study. We conducted a retrospective study based on a propensity score and a proportional hazards model.
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