Bleeding avoidance strategies among patients undergoing percutaneous coronary intervention

Evaluation of: Marso SP, Amin AP, House JA et al.: Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA 303(21), 2156–2164 (2010). Major bleeding during percutaneous coronary intervention (PCI) is associated with an adverse outcome. While a number of models exist to identify patients at risk of bleeding during PCI, it is not known whether targeted bleeding avoidance strategies lead to a reduction in major bleeding rates in these patient groups. This study aimed to address this knowledge gap and examined the use of two bleeding avoidance strategies: vascular closure devices and bivalirudin. Periprocedural major bleeding rates were obtained from a very large national registry of 1,522,935 patients undergoing procedures at 955 US centers. Bleeding occurred in 2% of patients. Use of one or more of these strategies resulted in reduced bleeding rates in both high- and low-risk cohorts. When both strategies...