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PubMed1991

The management of variceal bleeding.

Variceal bleeding has a high mortality, as the majority of patients have cirrhosis, with hepatic coma, renal failure, ascites and clotting deficiencies as complicating factors. Bleeding varices must therefore be treated as an emergency. Resuscitation, endoscopic diagnosis and haemostasis are the cornerstones of treatment. Once bleeding varices have been identified, attempts to stop the bleeding must be made at once as this will lessen the chances of hepatic failure developing. Endoscopic sclerotherapy at the time of diagnosis is the best available treatment at present, although profusely bleeding varices can be difficult to see and inject. In these circumstances the passage of a Sengstaken tube should stop the bleeding, allowing later sclerotherapy to be successful. If rebleeding recurs and cannot be controlled, oesophageal transection with a stapling gun may be life-saving, although the varices may later recur and long-term endoscopic follow-up will be necessary. Portacaval shunting and the distal splenorenal shunt involve arduous surgery and are followed by a significant incidence of hepatic encephalopathy; they should be reserved for those few cases when simpler measures have failed, although shunts do lead to permanent decompression of the portal system. The acute variceal bleed may also be dealt with pharmacologically. Vasopressin, used in combination with nitroglycerin to lessen the harmful side-effects, is cheaper and as effective as terlipressin or somatostatin and its synthetic analogue octreotide. Several courses of injection sclerotherapy will be required to eliminate oesophageal varices. Thereafter, long-term follow-up will be necessary to deal with any recurrence. The place of non-selective beta-blockers is still contentious, but they do reduce portal pressure and may lessen the chance of rebleeding. There is also a growing role for hepatic transplantation, which not only eliminates the varices but also restores liver function to normal and greatly reduces the risk of subsequent hepatoma development.

Catheterization↗
PubMed1993

Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass.

This prospective study of 36 adult patients undergoing cardiopulmonary bypass (CPB) was conducted to determine the utility of thromboelastography (TEG) versus platelet studies (bleeding time, platelet count, mean platelet volume) and standard coagulation tests (prothrombin time, activated partial thromboplastin time, fibrinogen) to more effectively discriminate patients likely to benefit from platelet or fresh frozen plasma (FFP) transfusion. Although the sensitivities of the bleeding time (71.4%) and platelet count (100%) were similar to the TEG (71.4%), the specificity (89.3%) of the TEG was greater than that of the bleeding time (78.5%) and platelet count (53.6%). Seven patients experienced clinically significant hemorrhage; 5 (71.4%) had an abnormal TEG. Three of 8 (38%) other patients with an abnormal TEG had no abnormal bleeding. Only 2 of 27 (7.4%) patients with a normal TEG had abnormal bleeding requiring platelet or FFP transfusion. Therefore, it is suggested that post-CPB patients with a normal TEG should not receive platelet or FFP transfusions empirically. If excessive bleeding is noted in a patient with a normal TEG, this suggests a surgically correctable etiology. Data from this series suggest that patients displaying an abnormal TEG appear to be at increased risk for hemorrhage; therefore, appropriate blood product support should be initiated at the first sign of accelerated bleeding.

Adolescent↗
PubMed2005

The relation of renal function to ischemic and bleeding outcomes with 2 different glycoprotein IIb/IIIa inhibitors: the do Tirofiban and ReoPro Give Similar Efficacy Outcome (TARGET) trial.

BACKGROUND: Renal function significantly impacts morbidity and mortality after a percutaneous coronary intervention. Platelet glycoprotein (GP) IIb/IIIa inhibitors reduce ischemic complications during percutaneous coronary intervention; little is known of whether their safety and efficacy are influenced by renal function. In particular, whether outcome differences exist between agents that are renally excreted (tirofiban) or not (abciximab) in patients with mild renal impairment is not known. METHODS: The TARGET trial randomized 4623 patients to tirofiban or abciximab. In this analysis, patients were grouped in creatinine clearance quartiles (<70, 70-90, 90-114, >114 mL/min) and analyzed for efficacy and bleeding risk. Univariate and multivariate analyses were performed to identify interactions between GP IIb/IIIa inhibitor used and creatinine clearance with respect to ischemic outcomes and bleeding. RESULTS: Using unadjusted logistic regression tests for trend, 30-day death/myocardial infarction/urgent target vessel revascularization was greater in patients with lower creatinine clearances (7.3%, 8.5%, 5.1%, and 5.8%, P = .005), as were both major and minor bleeding. There was no interaction between assigned GP IIb/IIIa inhibitor, creatinine clearance and ischemic outcome, major bleeding or minor bleeding. CONCLUSIONS: Both ischemic and bleeding complications are highest in the lowest creatinine clearance quartile of patients treated with GP IIb/IIIa inhibitors. Although tirofiban is renally cleared and abciximab is not, there was no interaction between these GP IIb/IIIa inhibitors and creatinine clearance regarding ischemic or bleeding events.

Abciximab↗
PubMed2006

Antepartum vaginal bleeding, fetal exposure to oral pathogens, and risk for preterm birth at <35 weeks of gestation.

OBJECTIVE: The purpose of this study was to determine the risks for fetal exposure to oral pathogens and the relationship between vaginal bleeding and fetal exposure in preterm birth risk. STUDY DESIGN: An analysis of prospectively collected data for the longitudinal Oral Conditions and Pregnancy Study was conducted. Maternal factors that potentially were associated with fetal exposure to oral pathogens (defined as detection of umbilical cord serum Immunoglobulin M to 1 of 5 oral pathogens) were examined, and the role of vaginal bleeding and fetal exposure to oral pathogens in preterm birth risk was explored. Preterm birth was defined as delivery at <35 weeks of gestation. An adjusted relative risk (95% CI) for fetal exposure was calculated. Adjusted hazard ratios (95% CI) were calculated for preterm birth among women whose data were stratified by the presence/absence of bleeding and/or fetal exposure to oral pathogens. RESULTS: There were complete data for 661 women; 230 women (34.8%) with and 431 women (65.2%) without fetal exposure to oral pathogens. In multivariable analysis, first- or second-trimester bleeding and white race were associated significantly with fetal exposure to oral pathogens (adjusted relative risk, 1.8 [95% CI, 1.3-2.5] and 1.3 [95% CI, 1.1-1.7], respectively). The adjusted hazard ratio for preterm birth among women with first- or second-trimester bleeding and fetal exposure to oral pathogens was 6.4 (95% CI: 2.6-16.0). CONCLUSION: Vaginal bleeding is associated with fetal exposure to oral pathogens, which increases preterm birth risk. Whether bleeding is the cause of or result of fetal exposure to oral pathogens remains to be determined.

Adult↗
PubMed2005

Bleeding in cardiac surgery: its prevention and treatment--an evidence-based review.

Expected and unexpected bleeding occur frequently in patients undergoing cardiac surgery. Bleeding after cardiac surgery can be broadly divided into two groups: surgical (unrecognized bleeding vessel, anastomosis, or other suture line) or nonsurgical bleeding (caused by coagulopathy). Factors influencing both surgical and nonsurgical bleeding can be further broken down into those occurring preoperatively and those that occur intraoperatively and postoperatively. A thorough understanding of these factors is necessary to reduce bleeding. This is a desirable clinical goal, because excessive bleeding is associated with adverse outcomes.

Algorithms↗
PubMed2004

Effect of mefenamic acid on controlling irregular uterine bleeding in DMPA users.

The objective of this double-blind, placebo-controlled study was to evaluate the effect of mefenamic acid and placebo on controlling irregular uterine bleeding in depot-medroxyprogesterone acetate (DMPA) users. A total of 48 DMPA users attending the Family Planning Clinic, Chulalongkorn Hospital were studied, all had abnormal bleeding. These participants were randomly divided into two groups. A total of 23 users received mefenamic acid, 500 mg, twice a day for 5 days, and placebos were given to the other 25 in the same manner. Total days of bleeding and spotting and percentage of women in whom bleeding was stopped were analyzed in the first and the fourth week. Percentage of subjects in whom bleeding was stopped during the first week after initial treatment was significantly higher in the mefenamic acid group than the placebo group (69.6%, 40.0%; p < 0.05). During the follow-up period (4 weeks after initial treatment), the mean of the bleeding-free interval during 28 days was found to be 16.1 days in the subjects treated with mefenamic acid and 12.39 days in the placebo group. However, the difference was not statistically significant. From the results of the study, we concluded that mefenamic acid was effective in very short-term control of bleeding during DMPA use, but not effective long-term.

Adult↗
PubMed2005

The effect of tranexamic acid for treatment of irregular uterine bleeding secondary to Norplant use.

OBJECTIVE: The purpose of this study is to evaluate the effects of tranexamic acid and placebo on controlling irregular uterine bleeding secondary to Norplant use. MATERIALS AND METHODS: A prospective randomized, double-blind, placebo-controlled trial was conducted. Sixty-eight Norplant users who had irregular bleeding were randomly allocated into two groups. A total of 34 users received tranexamic acid 500 mg twice a day for 5 days; the placebo was given to the other 34 users in the same manner. The total number of days of bleeding and spotting and the percentage of women whose irregular uterine bleeding was stopped was analyzed at the end of weeks 1 and 4. RESULTS: In the follow-up period (4 weeks after the initial treatment), a bleeding-free interval of > 20 days was found in 58.8% of the subjects treated with tranexamic acid and in 76.5% treated with placebo (p = .12). The percentage of subjects whose irregular uterine bleeding stopped during week 1 after the initial treatment was significantly higher in the tranexamic acid group than those in the placebo group (64.7% vs. 35.3%, p = .015). The mean number of bleeding/spotting days was not significantly different between the groups (15.4 vs. 12.7 days, p = .182). CONCLUSIONS: Tranexamic acid for 5 days appears to be an effective treatment for irregular uterine bleeding associated with Norplant use only while it is being used. However, treatment for 5 days does not seem to provide long-term benefit.

Adult↗
PubMed2006

Bleeding patterns of adolescents using a combination contraceptive injection for 1 year.

PURPOSE: This prospective observational study evaluated the bleeding patterns of adolescents receiving a monthly injectable contraceptive containing norethisterone enanthate 50 mg plus estradiol valerate 5 mg. MATERIALS AND METHODS: The study enrolled 73 volunteers aged between 14 and 19 years; of these patients, 38 (52%) recorded their menstrual cycles during 1 year. RESULTS: After 1 year of using the contraceptive, most of the 38 women (71.1%) had adequate menstrual patterns (two to four bleeding episodes; none lasting 10 days or longer; with a range of bleeding-free intervals not exceeding 17 days), 23.7% reported prolonged bleeding episodes, 2.6% had irregular bleeding and 2.6% had amenorrhea. Only 1 of the 38 teenagers is known to have discontinued the method due to bleeding. Among these 38 adolescents, dissatisfaction with bleeding patterns was not a frequent reason given for discontinuation of the monthly injectable contraceptive.

Adolescent↗
PubMed2006

Improved survival of patients presenting with acute variceal bleeding. Prognostic indicators of short- and long-term mortality.

BACKGROUND AND AIM: Variceal bleeding is a severe complication of portal hypertension with a mortality rate between 30% and 60% in previous studies. During the last two decades the treatment of these patients has been improved. The aim of this study was to investigate the clinical outcome of patients after an episode of acute variceal bleeding and to identify risk factors for early and late mortality in these patients. MATERIALS AND METHODS: All patients with acute variceal bleeding hospitalised at two large hospitals between January 1, 1999 and June 30, 2004, were retrospectively enrolled in this study. After discharge, patients were followed until death or study closure date, on June 30, 2005. Bleeding related mortality, 6-week, 1-year and overall mortality were evaluated as well as factors related to early and late mortality. RESULTS: One hundred and forty one patients were included (114 men, 27 women) with a mean age of 60.5+/-13.5 years. In hospital, 6-week, 1-year and overall mortality were 12.1%, 18.4%, 32.6% and 48.2%, respectively. The mean length of hospitalisation was 11.4+/-9 days (1-55) and the mean packed red blood cell requirement was 3.9+/-3.7 (0-25). The rate of recurrent bleeding was 10.7% during initial hospitalisation. Being Child-Pugh C (p=0.003) and shock on admission (p=0.037) were independent predictors of 6-week mortality, while being Child-Pugh C (p=0.028), presence of hepatocellular carcinoma or other neoplasia (p=0.04) and partial thromboplastin time (p=0.021) during the initial admission were independent predictors for 1-year mortality. Mortality was not affected by the presence of active bleeding and/or white nipple at emergency endoscopy. Also presence of infection was not an adverse factor of clinical outcome in our patients. CONCLUSIONS: In conclusion, the clinical outcome of patients with acute variceal bleeding is better in comparison with previous studies. The severity of liver failure as well as the presence of neoplasia mainly affects the survival.

Acute Disease↗
PubMed2007

Topical use of antifibrinolytic agents reduces postoperative bleeding: a double-blind, prospective, randomized study.

OBJECTIVE: Postoperative bleeding is still one of the most common complications of cardiac surgery. Antifibrinolytic agents successfully reduce bleeding, but there are controversies concerning adverse effects after their systemic use. By topical application of antifibrinolytic agents in pericardial cavity, most of these effects are avoided. We compared the effects of topically applied aprotinin, tranexamic acid and placebo on postoperative bleeding and transfusion requirements. METHODS: In this single-center prospective, randomized, double-blind trial, 300 adult cardiac patients were randomized into three groups to receive one million IU of aprotinin (AP group), 2.5g of tranexamic acid (TA group) or placebo (PL group) topically before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 12-h period (AP group 433+/-294 [350; 360]ml, TA group 391+/-255 [350; 305]ml, PL group 613+/-505 [525; 348]ml), as well as cumulative blood loss within 24h (AP group 726+/-432 [640; 525]ml, TA group 633+/-343 [545; 335]ml, PL group 903+/-733 [800; 445]ml), showed statistically significant inter-group differences (both p<0.001). Bleeding rates values were significantly higher in placebo group compared to the groups treated with antifibrinolytic agents (AP and TA groups) concerning both variables. Although TA group showed the lowest values, no statistical differences between TA and AP groups were found. Inter-group difference of blood product requirements was not statistically significant. CONCLUSIONS: Topical use of either tranexamic acid or aprotinin efficiently reduces postoperative bleeding. TA seems to be at least as potent as aprotinin, but potentially safer and with better cost-effectiveness ratio.

Administration, Topical↗
PubMed2006

The incidence and characteristics of uterine bleeding during postoperative GnRH agonist treatment combined with tibolone add-back therapy in endometriosis patients of reproductive age.

OBJECTIVES: This study was undertaken to evaluate the incidence and the factors associated with uterine bleeding while taking GnRH agonist treatment combined with tibolone add-back therapy in endometriosis patients of reproductive age. STUDY DESIGN: The medical records of 188 endometriosis (stages III-IV) patients of reproductive age receiving postoperative GnRH agonist treatment combined with tibolone add-back therapy for 6 months were reviewed. Clinical features were analyzed and compared between the two groups: Group A, patients without an episode of uterine bleeding (n=137) and Group B, patients that had experienced uterine bleeding (n=51). RESULTS: Demographic profiles were not different in the two groups. The incidence of uterine bleeding was 27.1% and irregular spotting was the most frequent bleeding pattern. The proportion of patients who received ovarian surgery during pelviscopy was higher in Group B (p<0.05), but other clinical characteristics were not different between two groups. CONCLUSIONS: The incidence of uterine bleeding was 27.1%. And, the proportion of patients who received ovarian surgery was higher in patients with uterine bleeding.

Adult↗
PubMed2006

Double-balloon enteroscopy in patients with GI bleeding of obscure origin.

BACKGROUND: Small-bowel bleeding is difficult to treat and diagnose. The recent introduction of wireless capsule endoscopy permits examination of the entire small intestine, but this method lacks tissue sampling and therapeutic capabilities. Recently, Yamamoto et al established a double-balloon insertion method for enteroscopy that allows examination of the entire small bowel and interventional options. OBJECTIVE: To evaluate double-balloon enteroscopy in patients with obscure GI bleeding. SETTING: Single-center prospective study. PATIENTS: Thirty-one consecutive patients with obscure GI bleeding (13 females, 18 males; mean age 56.4 +/- 3.2 years). Criteria for inclusion in the study were documented iron deficiency anemia (hemoglobin level <10 g/dL or a decrease of >2 g/dL over > or =2 months); upper endoscopy not revealing a site/cause of blood loss; and similarly uninformative lower endoscopy including examination of the terminal ileum. INTERVENTIONS: Endoscopic biopsy or therapy was performed as clinically indicated. MAIN OUTCOME MEASUREMENTS: Diagnostic yield for patients with obscure GI bleeding and patient follow-up. RESULTS: Double-balloon enteroscopy was completed without complications in all patients. Bleeding points were identified in 23 patients (74.2%). In 21 (91.3%) of these 23 patients the cause of blood loss was identified and treated with no further bleeding at 8.5 +/- 0.6 months of follow-up. LIMITATIONS: Small number of patients. CONCLUSIONS: These data suggest that double-balloon enteroscopy is useful for evaluation and treatment of patients with GI bleeding of obscure origin.

Adolescent↗
PubMed2005

Gastrointestinal bleeding.

Gastrointestinal bleeding encompasses a broad array of clinical scenarios. The spectrum is diverse because of the multiple types of lesions that can cause bleeding, and because bleeding can occur from virtually anywhere in the gastrointestinal tract. The fundamental tenets of management of patients with gastrointestinal bleeding include the following: (1) the patient must undergo immediate assessment and stabilization of hemodynamic status, (2) the source of bleeding must be identified, (3) active bleeding should be stopped, (4) the underlying abnormality should be treated, and (5) recurrent bleeding should be "prevented.

Clinical Trials as Topic↗
PubMed2004

A daily diary analysis of vaginal bleeding and coitus among adolescent women.

OBJECTIVE: To evaluate the effect of vaginal bleeding on the likelihood of coitus among adolescent women. METHODS: Participants were 191 sexually active women aged 14 to 21 years enrolled from a sexually transmitted disease clinic and three primary care adolescent clinics. Data were collected from diaries maintained for up to 7 months. Subjects recorded each occurrence of coitus, partner initials, condom use, and vaginal bleeding. Multivariable logistic regression was used for the analyses. Generalized estimating equations approach was used to adjust the estimated parameters for within-subject correlation. RESULTS: Subjects reported a total 21334 diary days, with 2684 days with coitus (12.6% of diary days) and 1433 days with bleeding (6.7% of diary days). Only 65/2684 (2.4%) coital events were associated with vaginal bleeding. Multivariable analysis showed that absence of bleeding was associated with increased likelihood (odds ratio = 4.2) of coitus, independent of age, race, and usual coital frequency. Younger age and higher coital frequency were associated with increased likelihood of any coitus during vaginal bleeding. CONCLUSIONS: For most sexually active adolescent women, bleeding is associated with avoidance of coitus.

Adolescent↗
PubMed2004

Current treatment of dysfunctional uterine bleeding.

OBJECTIVES: We performed a review of the treatment modalities for dysfunctional uterine bleeding. METHODS: Dysfunctional uterine bleeding can be treated medically or surgically. Medical treatment consists of anti-fibrinolytic tranexamic acid, non-steroidal anti-inflammatory drugs, the combined contraception pill, progestogen, danazol, or analogues of gonadotrophin releasing hormone. The levonorgestrel releasing intra uterine device is developed for contraception, but is also effective in the treatment of dysfunctional uterine bleeding. Surgical treatment includes endometrial ablation of the first and second-generation, and hysterectomy. This review contains current available evidence on the effectiveness of these therapies. RESULTS: Antifibrinolytic tranexamic acid is the most effective medical therapy to treat dysfunctional uterine bleeding. In general medical therapy is not as effective as endometrial resection in terms of patient satisfaction and health related quality of life. The levonorgestrel releasing intra uterine device is an effective treatment for dysfunctional uterine bleeding. No difference in quality of life was observed in patients treated with a levonorgestrel releasing intra uterine device as compared to hysterectomy. Ablation techniques of the first generation are effective and safe when used by trained surgeons, but have a learning curve. Ablation techniques of the second generation are effective, but long-term follow-up data are not available. Similarly, there are no large randomised controlled trials comparing the levonorgestrel releasing intra uterine device to first and second-generation ablation techniques. Hysterectomy, the traditional standard of care, has a relatively high complication rate, but it generates a high satisfaction rate and good health related quality of life scores. CONCLUSION: Since none of the treatments for dysfunctional bleeding is superior to one of the others, and since all treatments have their advantages and disadvantages, counselling of patients with dysfunctional bleeding should incorporate medical approach, levonorgestrel releasing IUD, endometrial ablation and hysterectomy.

Catheter Ablation↗
PubMed2005

Occult bleeding in three different antithrombotic regimes after myocardial infarction. A WARIS-II subgroup analysis.

INTRODUCTION: Warfarin, aspirin, and the combination of these, have all proven to be efficacious in preventing future events after myocardial infarction. The accompanying bleeding tendency is a concern. The aim of the present study was to compare the occurrence of occult bleeding and iron deficiency during these treatment modalities. METHODS: The 267 patients who had survived a myocardial infarction were randomly assigned in the Warfarin Aspirin Reinfarction Study to treatment with aspirin 160 mg/day, or warfarin (INR 2.8-4.2), or aspirin 75 mg/day plus warfarin (INR 2.0-2.5). The patients were screened for the occurrence of occult bleeding in faeces and urine after 3 months. Haemoglobin and iron metabolism parameters were measured at baseline, after 3 months, and at the end of the 4 years follow-up. RESULTS: The number of occult bleeding in faeces was 19 (7.1%) and in urine 29 (10.9%). There were no intergroup differences (p=0.45 and 0.39, respectively). In the occult bleeders, a second test showed 3 (1.1%) positive samples in faeces and 9 (3.4%) in urine. Further investigation revealed 2 cases of malignant disease. Haemoglobin and iron status variables were all within normal limits after 3 months and after 4 years in all treatment groups. CONCLUSIONS: Long-term treatment with aspirin, warfarin, or both, in the present doses and levels of anticoagulation did not lead to anemia or iron deficiency. The occurrence of occult bleeding in faeces and urine was a temporary phenomenon in most patients. Only macroscopic bleedings during these treatment modalities were of clinical importance, and screening for occult bleeding was of limit value.

Anticoagulants↗
PubMed1982

Detection of gastrointestinal bleeding with 99mTc-labeled red blood cells.

Using a modified in vivo Tc-99M red cell labeling technique, gastrointestinal bleeding scintigraphy was performed in 100 patients with GI bleeding. Sixty-two patients with melena or bright red blood per rectum had positive scintiscans. In comparison to results of angiography, endoscopy, surgery and contrast radiography, radionuclide scintigraphy correctly located the site of bleeding in 83% of patients. The procedures could be performed over a 24 hr period which increased the sensitivity of the test since 85% of the scintiscans were positive at one hr or greater after the onset of imaging. The procedure was more sensitive than angiography in detecting sources of GI bleeding. We conclude that GI bleeding scintigraphy 99mTc-red cells in an accurate and effective method to detect upper and lower GI bleeding in patients with acute intermittent gastrointestinal bleeding.

Adolescent↗
PubMed2003

Bleeding risk of platelet glycoprotein IIb/IIIa receptor antagonists in broad-based practice (results from the Society for Cardiac Angiography and Interventions Registry).

Randomized trials of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors in patients who have undergone percutaneous coronary intervention (PCI) have shown a modest increase in bleeding risk associated with GP IIb/IIIa inhibitor use. Because clinical trials often enroll highly selected patient populations and are performed in high-volume experienced centers, these results may not apply to a nonclinical trial population, thus altering the risk-benefit ratio of the drugs. Given the widespread use of these agents, we sought to determine bleeding risks in a broad-based population of patients who underwent PCI. We performed a retrospective cohort study of GP IIb/IIIa inhibitors and bleeding in 18,821 procedures from June 1, 1996 to December 31, 1998 using the Society for Cardiac Angiography and Interventions Registry. The primary outcome was bleeding events, defined as clinically significant hematoma formation or hemorrhage. Bleeding risk was 1.9% in the 2,525 patients who received GP IIb/IIIa inhibitors compared with 1.0% in the 16,296 who did not (unadjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.35 to 2.59, p <0.001). After adjustment for multiple clinical and procedural variables, the effect was attenuated, with at most a twofold bleeding risk associated with GP IIb/IIIa inhibitor use (adjusted OR 1.39, 95% CI 0.96 to 2.03, p = 0.083). The small increase in absolute risk of bleeding from GP IIb/IIIa inhibitor use in this study is similar to the risk observed in clinical trials. Assuming these agents are as effective as shown in these trials, the risk-benefit ratio of GP IIb/IIIa inhibitors in broad-based PCI practice should be favorable.

Aged↗