Bleeding Risk after Contemporary Thrombolytic Therapy Following Myocardial Infarction

Description

Patients receiving thrombolytic therapy following myocardial infarction may experience bleeding as a complication. The risk for moderate to severe bleeding can be estimated from the thrombolytic regimen and clinical features of the patient.

Patients studied: The 41,021 patients in the GUSTO-I trial.

Therapeutic regimens:

(1) streptokinase (SK) plus subcutaneous heparin

(2) streptokinase plus IV heparin

(3) tissue plasminogen activator (tPA)

(4) combination therapy of tPA plus streptokinase plus IV heparin

The most common sources of bleeding were procedure related, with lower rates if the patient did not undergo catheterization or other invasive procedure.

Risk factors associated with hemorrhage:

(1) therapeutic regimens: streptokinase + IV heparin; combination regimen

(2) older age

(3) lighter body weight

(4) female sex

(5) African ancestry

Prediction of Moderate or Severe Bleeding Event with Invasive Procedure

Parameter	Finding	Points
age in years	30	18
	40	27
	50	36
	60	45
	70	54
	80	63
	90	72
body weight in kilograms	40	87
	60	74
	80	61
	100	52
	120	43
	140	35
diastolic blood pressure	60	30
	80	25
	100	21
	120	17
	140	13
	160	8
	180	4
	200	0
pulse in beats per minute	0	0
	40	4
	80	8
	120	12
	160	16
	200	19
	240	23
miscellaneous risk factors	female sex	12
	African ancestry	10
	current smoker	8
	hypertension	7
	previous angina	3
	previous myocardial infarction	2
Killip class and treatment interaction	Killip I and streptokinase + subcutaneous heparin	38
	Killip I and TPA	32
	Killip I and streptokinase + IV heparin	43
	Killip I and combination therapy (SK+TPA)	39
	Killip II and streptokinase + subcutaneous heparin	46
	Killip II and TPA	39
	Killip II and streptokinase + IV heparin	50
	Killip II and combination therapy (SK+TPA)	42
	Killip III and streptokinase + subcutaneous heparin	53
	Killip III and TPA	48
	Killip III and streptokinase + IV heparin	57
	Killip III and combination therapy (SK+TPA)	54
	Killip IV and streptokinase + subcutaneous heparin	60
	Killip IV and TPA	55
	Killip IV and streptokinase + IV heparin	65
	Killip IV and combination therapy (SK+TPA)	60

total points =

= SUM(all predictive factors present)

Total Points	Risk of Moderate to Severe Bleeding
182	10%
210	20%
228	30%
243	40%
257	50%
271	60%
286	70%

if this data is plugged into JMP,

risk of bleeding in percent =

= (0.0022386 * ((points) ^2)) - (0.454114 * (points)) + 17.819422

Risk of Bleeding in Noncatheterized Patients

Parameter	Finding	Points
age in years	40	0
	50	6
	60	18
	70	29
	80	41
	90	53
	100	64
	110	76
body weight in kilograms	40	37
	60	20
	80	4
	100	0
	120	0
pulse in beats per minute	40	91
	60	91
	80	96
	100	100
	120	98
	140	91
	160	77
	180	57
	200	32
miscellaneous risk factors	female sex	12
	streptokinase + IV heparin treatment	13
ancestry + TPA use	non-African and no TPA	0
	non-African and TPA	0
	African and no TPA	15
	African and TPA	43
Killip class and combination therapy	Killip I and no combo therapy	3
	Killip I and combo therapy	15
	Killip II and no combo therapy	0
	Killip II and combo therapy	25
	Killip III or IV and no combo therapy	7
	Killip III or IV and combo therapy	11

total points =

= SUM(all predictive factors present)

Total Points	Risk of Moderate to Severe Bleeding
142	5%
162	10%
175	15%
185	20%
192	25%
199	30%
206	35%
211	40%
217	45%
223	50%

if this data is plugged into JMP,

risk of bleeding in percent =

= (0.005285 * ((points) ^2)) - (1.367107 * (points)) + 92.553427

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Description

Specialty

ICD-10