Reduction of risk of hemorrhagic complications in patients with acute myocardial infarction
The information of drugs, that affect platelet aggregation and plasma factors of blood coagulation, is presented. These medications are included in international and national standards in providing care to patients with acute myocardial infarction. In present time the identified factors of increased risk of bleeding are following: old age, anemia, renal failure, heart rate, blood pressure levels, diabetes mellitus, cardiovascular disease, intake of warfarin, as well as body weight and the number of leukocytes in the blood. The results of modern international population studies (CRUSADE, ACUITY-HORIZONS and ACTION-GWTG) are listed. According to these findings mentioned factors in various ratios are included in the three established scales of risk assessment. Their use allows to determine the population risk of bleeding in patients with myocardial infarction with and without elevation of the ST segment on the electrocardiogram. At the same time, the individual predictive value of increase bleeding factors, especially for low-risk patients, remains very modest. We presented possible approaches to reduce the risk of hemorrhagic complications in patients with myocardial infarction in the choice of anticoagulants and desegregated druges. Thus, in patients with a high risk of bleeding, a reasonable selection of heparin therapy is needed to control access of laboratory monitoring of activated partial thromboplastin time, and an antidote (protamine sulfate).