What question did this study set out to answer?

To describe the utilization of vascular closure devices and bivalirudin and evaluate their association with post-procedural bleeding rates across patient preprocedural risk strata.

June 1, 2010JAMA

Association Between Use of Bleeding Avoidance Strategies and Risk of Periprocedural Bleeding Among Patients Undergoing Percutaneous Coronary Intervention

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Why the study?

Do bleeding avoidance strategies (vascular closure devices and/or bivalirudin) reduce periprocedural bleeding in patients undergoing PCI?

Population

1,522,935 patients undergoing percutaneous coronary intervention procedures at 955 US hospitals…

Comparison

Bleeding avoidance strategies: vascular closure… vs Manual compression.

Design

Cohort

Follow-up

periprocedural

Authors

SMSteven P. MarsoInterventional Cardiology

Discussion

Member takes

Implication

Bleeding avoidance strategies were associated with lower PCI bleeding rates; hypothesis-generating and should not yet change practice.

Key Points

To describe the utilization of vascular closure devices and bivalirudin and evaluate their association with post-procedural bleeding rates across patient preprocedural risk strata.
Analyzed data from N=1,522,935 patients undergoing percutaneous coronary intervention across 955 US hospitals in the NCDR CathPCI Registry from January 1, 2004, through September 30, 2008.
Evaluated four bleeding avoidance approaches: manual compression, vascular closure devices alone, bivalirudin alone, and both strategies combined.
Stratified post-PCI bleeding rates across low, intermediate, and high preprocedural risk tiers and adjusted outcomes using propensity-matched and site-controlled models.
Periprocedural bleeding occurred in 2.0% of patients overall (30,654 patients), with rates of 2.8% for manual compression, 2.1% for vascular closure devices, 1.6% for bivalirudin, and 0.9% for combined strategies (P < .001).
Among high-risk patients, bleeding rates were significantly reduced with combined strategies compared to manual compression (2.3% vs 6.1%, P < .001), an association that persisted after propensity-matched adjustment.
Vascular closure devices plus bivalirudin were utilized least frequently in high-risk patients compared to low-risk patients (14.4% vs 21.0%, P < .001).

Structured PICO

Do bleeding avoidance strategies (vascular closure devices and/or bivalirudin) reduce periprocedural bleeding in patients undergoing PCI?

Population

1,522,935 patients undergoing percutaneous coronary intervention (PCI) procedures at 955 US hospitals participating in the NCDR CathPCI Registry from January 1, 2004, through September 30, 2008.

Intervention

Bleeding avoidance strategies: vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin.

Comparator

Manual compression.

Outcome

Periprocedural bleeding.safety

Bleeding avoidance strategies (bivalirudin and vascular closure devices) significantly reduce periprocedural bleeding in PCI, particularly in high-risk patients, but are paradoxically underutilized in this vulnerable group.

Cite This Study

Steven P. Marso (2010) studied this question.

synapsesocial.com/papers/69fc04f93a0f4cc134c8ee00 https://doi.org/10.1001/jama.2010.708

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Association Between Use of Bleeding Avoidance Strategies and Risk of Periprocedural Bleeding Among Patients Undergoing Percutaneous Coronary Intervention

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Association Between Use of Bleeding Avoidance Strategies and Risk of Periprocedural Bleeding Among Patients Undergoing Percutaneous Coronary Intervention

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

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