Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention

Steven P. Marso, Amit P. Amin, John A. House, Kevin F. Kennedy, John A. Spertus, Sunil V. Rao, David J. Cohen, John C. Messenger, John S. Rumsfeld

Research output: Contribution to journalArticle

225 Citations (Scopus)

Abstract

Context: Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown. Objective: To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population. Design, Setting, and Patients: Analysis of data from 1 522 935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008. Main Outcome Measure: Periprocedural bleeding. Results: Bleeding occurred in 30 654 patients (2%). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35%, 24%, 23%, and 18% of patients, respectively. Bleeding events were reported in 2.8% of patients who received manual compression, compared with 2.1%, 1.6%, and 0.9% of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P<.001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72%; intermediate risk, 1.73%; high risk, 4.69%). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1%; vascular closure devices, 4.6%; bivalirudin, 3.8%; vascular closure devices plus bivalirudin, 2.3%; P<.001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4% vs 21.0% in low-risk patients, P<.001). Conclusions: In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.

Original languageEnglish (US)
Pages (from-to)2156-2164
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number21
DOIs
StatePublished - Jun 2 2010

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Percutaneous Coronary Intervention
Hemorrhage
Registries
bivalirudin
Vascular Closure Devices

ASJC Scopus subject areas

  • Medicine(all)

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Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. / Marso, Steven P.; Amin, Amit P.; House, John A.; Kennedy, Kevin F.; Spertus, John A.; Rao, Sunil V.; Cohen, David J.; Messenger, John C.; Rumsfeld, John S.

In: JAMA - Journal of the American Medical Association, Vol. 303, No. 21, 02.06.2010, p. 2156-2164.

Research output: Contribution to journalArticle

Marso, Steven P. ; Amin, Amit P. ; House, John A. ; Kennedy, Kevin F. ; Spertus, John A. ; Rao, Sunil V. ; Cohen, David J. ; Messenger, John C. ; Rumsfeld, John S. / Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. In: JAMA - Journal of the American Medical Association. 2010 ; Vol. 303, No. 21. pp. 2156-2164.
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abstract = "Context: Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown. Objective: To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population. Design, Setting, and Patients: Analysis of data from 1 522 935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008. Main Outcome Measure: Periprocedural bleeding. Results: Bleeding occurred in 30 654 patients (2{\%}). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35{\%}, 24{\%}, 23{\%}, and 18{\%} of patients, respectively. Bleeding events were reported in 2.8{\%} of patients who received manual compression, compared with 2.1{\%}, 1.6{\%}, and 0.9{\%} of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P<.001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72{\%}; intermediate risk, 1.73{\%}; high risk, 4.69{\%}). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1{\%}; vascular closure devices, 4.6{\%}; bivalirudin, 3.8{\%}; vascular closure devices plus bivalirudin, 2.3{\%}; P<.001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4{\%} vs 21.0{\%} in low-risk patients, P<.001). Conclusions: In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.",
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T1 - Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention

AU - Marso, Steven P.

AU - Amin, Amit P.

AU - House, John A.

AU - Kennedy, Kevin F.

AU - Spertus, John A.

AU - Rao, Sunil V.

AU - Cohen, David J.

AU - Messenger, John C.

AU - Rumsfeld, John S.

PY - 2010/6/2

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N2 - Context: Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown. Objective: To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population. Design, Setting, and Patients: Analysis of data from 1 522 935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008. Main Outcome Measure: Periprocedural bleeding. Results: Bleeding occurred in 30 654 patients (2%). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35%, 24%, 23%, and 18% of patients, respectively. Bleeding events were reported in 2.8% of patients who received manual compression, compared with 2.1%, 1.6%, and 0.9% of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P<.001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72%; intermediate risk, 1.73%; high risk, 4.69%). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1%; vascular closure devices, 4.6%; bivalirudin, 3.8%; vascular closure devices plus bivalirudin, 2.3%; P<.001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4% vs 21.0% in low-risk patients, P<.001). Conclusions: In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.

AB - Context: Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown. Objective: To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population. Design, Setting, and Patients: Analysis of data from 1 522 935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008. Main Outcome Measure: Periprocedural bleeding. Results: Bleeding occurred in 30 654 patients (2%). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35%, 24%, 23%, and 18% of patients, respectively. Bleeding events were reported in 2.8% of patients who received manual compression, compared with 2.1%, 1.6%, and 0.9% of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P<.001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72%; intermediate risk, 1.73%; high risk, 4.69%). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1%; vascular closure devices, 4.6%; bivalirudin, 3.8%; vascular closure devices plus bivalirudin, 2.3%; P<.001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4% vs 21.0% in low-risk patients, P<.001). Conclusions: In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.

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