Expanded definition reveals post-PCI bleeding more common

Using an updated definition of post-PCI bleeding, an analysis of more than 1 million PCI procedures found that the rate of bleeding was 5.8 percent, more than double the previously reported rate of 2.4 percent. These findings were published in the September issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

The authors, led by Sunil V. Rao, MD, of Duke Clinical Research Institute in Durham, N.C., used clinical data from the National Cardiovascular Data Registry CathPCI Registry that included additional complications added in 2009.

In an effort to more accurately estimate post-procedure bleeding, an expert panel updated the definition of bleeding to include several more outcomes if they occurred within 72 hours after PCI or before discharge, including site-reported arterial access site bleeding; retroperitoneal, gastrointestinal or genitourinary bleeding; intracranial hemorrhage; cardiac tamponade; a post-PCI decrease in hemoglobin level of 3 g/dl in patients whose pre-PCI hemoglobin was 16 g/dl or less and a post-procedure nonbypass surgery-related blood transfusion.

“The updated bleeding definition identifies important post-PCI bleeding events,” the researchers wrote. “Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.”

There were also certain patient characteristics associated with bleeding, such as female sex, age older than 70, kidney function and body mass index.

The authors argued that their findings could encourage the more widespread use of bleeding avoidance strategies (BAS), such as bivalirudin, a radial approach or in some cases and vascular closure devices in patients at greater risk for bleeding.

“The distribution of risk using the new bleeding definition potentially broadens the proportion of patients who might benefit from BAS implementation, but future comparative effective studies are needed to confirm this hypothesis,” the researchers wrote.