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Higher Bleed Risk in Women With Acute Coronary Syndrome

Last Updated: May 18, 2009.

Women with acute coronary syndrome gained similar protection against ischemic events with bivalirudin compared to heparin plus a glycoprotein IIb/IIIa inhibitor, with less bleeding, according to research published in the May 1 issue of the American Journal of Cardiology.

MONDAY, May 18 (HealthDay News) -- Women with acute coronary syndrome (ACS) gained similar protection against ischemic events with bivalirudin compared to heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), with less bleeding, according to research published in the May 1 issue of the American Journal of Cardiology.

Alexandra J. Lansky, M.D., of the Columbia University Medical Center and Cardiovascular Research Foundation in New York City, and colleagues analyzed data from 13,819 patients with moderate or high-risk non-ST-elevation ACS. Patients were randomized to receive heparin plus a GPI, bivalirudin and a GPI, or bivalirudin only.

The researchers found that 30-day composite ischemia was similar in men and women. Women had higher 30-day rates of major bleeding (8 versus 3 percent) and net clinical outcomes, which included composite ischemia -- defined as death, myocardial infarction, or revascularization -- or bleeding (13 versus 10 percent). Women on bivalirudin had less 30-day major bleeding (5 versus 10 percent) but similar composite ischemia compared with those on heparin and a GPI, the authors note.

"Our study demonstrated that women presenting with ACS had more chronic kidney disease, diabetes, and hypertension, but had significantly less extensive and complex coronary artery disease, smaller vessels, better coronary flow, and myocardial perfusion than men. These factors likely account for the lower baseline cardiac markers and enzyme release observed in women and similar rates of mortality and ischemic events compared with men observed with all treatment strategies in this study," the authors conclude.

The trial that generated this study was sponsored by The Medicines Company.

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