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World Journal of Emergency Medicine

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Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis: a 5-year analysis in an Asian population

Hock Peng Koh1, Jivanraj R. Nagarajah1, Hasnita Hassan2, Noel Thomas Ross3   

  1. 1Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur 50586, Malaysia 
    2Emergency and Trauma Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur50586 , Malaysia
    3Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur 50586, Malaysia
  • Received:2024-03-26 Accepted:2024-06-04
  • Contact: Hock Peng Koh, E-mail:wilsonkoh821@gmail.com

Abstract: BACKGROUND: Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents. This study aimed to determine the incidence of bleeding, the bleeding characteristics and their mortality outcomes following ST-elevation myocardial infarction (STEMI) thrombolysis in an Asian population. 

METHODS: This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital. Total population sampling was used in this study. The primary outcome was bleeding events post-thrombolysis, categorised using the Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria. Inferential statistics were used to determine the associations between relevant variables.

RESULTS: Data from 941 patients were analysed. A total of 156 (16.6%) STEMI patients bled post-thrombolysis. Major, minor, and minimal TIMI occurred in 7 (0.7%), 17 (1.8%), and 132 (14.0%) patients, respectively. Age 65 years (P=0.031), Malaysian Chinese (P=0.008) were associated with a higher incidence of bleeding post-thrombolysis. Conversely, foreigners (P=0.032) and current smoker (P=0.007) were associated with a lower incidence of bleeding. Both TIMI major (P<0.001) and TIMI minor (P<0.001) were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients. TIMI minor bleeding was significantly higher in the streptokinase recipients (P=0.009). The bleeding sites were comparable between streptokinase and tenecteplase recipients, except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients (P=0.027). 

CONCLUSION: In our Asian population, the incidence of total bleeding events following STEMI thrombolysis  is comparable to that previously reported. The development of TIMI major and minor bleeding complications is associated with higher mortality. 


Key words: Bleeding, Tenecteplase, Streptokinase, ST-elevation myocardial infarction thrombolysis, Asian