Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions

Kinnaird, Timothy; Stabile, Eugenio; Mintz, Gary S.; Lee, Cheol Whan; Caños, Daniel; Gevorkian, Natalie; Pinnow, Ellen; Kent, Kenneth M.; Pichard, Augusto D.; Satler, Lowell F.; Weissman, Neil J.; Lindsay, Joseph; Fuchs, Shmuel

doi:10.1016/s0002-9149(03)00972-x

Cited by 494 publications

(178 citation statements)

References 23 publications

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“…The association of aspirin with increased risk of gastrointestinal (GI) bleeding has been recognized [10,11,12,13,14]. Bleeding in patients who have undergone PCI is associated with increased morbidity, mortality, duration of hospitalization, and cost [15,16,17,18,19]. Therefore, GI bleeding after PCI is an important target for preventive strategies for complications of antiplatelet therapy following PCI.…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Bleeding after Percutaneous Coronary Intervention

et al. 2011

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Percutaneous coronary intervention (PCI) is now performed in a wide range of patients with coronary artery disease. Complications of PCI include in-stent re-stenosis and in-stent thrombosis. According to the recent 2005 guidelines of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions, dual antiplatelet therapy with low-dose aspirin and thienopyridine derivatives such as ticlopidine and clopidogrel should be used in patients who have undergone PCI. A serious complication of dual antiplatelet therapy is bleeding, most of which arise from the gastrointestinal (GI) tract. In this article we review published studies about GI bleeding in patients who have undergone PCI. The prevalence of GI bleeding in patients who are administered dual antiplatelet therapy following PCI is approximately 2%, and GI bleeding after PCI is associated with increased morbidity, mortality, duration of hospitalization and cost. Advanced age, a history of peptic ulcer disease, co-administration of non-steroidal anti-inflammatory drugs, co-administration of anticoagulants, and physiological stress are considered to be the major risk factors for GI bleeding in patients undergoing antiplatelet therapy following PCI. Recent clinical and experimental studies indicate that administration of low-dose aspirin may also increase the risk of adverse events in the small intestine. Although some prophylactic strategies such as proton-pump inhibitor, H₂ receptor antagonist and eradication of Helicobacter pylori are proposed, there are few randomized controlled trials assessing the best strategy for the prevention of GI bleeding after PCI. Further extensive studies are required to ascertain the beneficial effect of prophylactic agents for dual antiplatelet therapy following PCI.

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Section: Introductionmentioning

confidence: 99%

Gastrointestinal Bleeding after Percutaneous Coronary Intervention

et al. 2011

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“…Several risk factors for the development of RPB after CC have been previously identified including female gender, low BMI, CRF, high femoral puncture site and the use of GP IIb-IIIa inhibitors [7,8,9,10,11,12]. Indeed, the majority of patients with RPB in our cohort were female but only few had a low BMI or CRF.…”

Section: Discussionmentioning

confidence: 71%

Retroperitoneal Bleeding after Cardiac Catheterization: A 7-Year Descriptive Single-Center Experience

Eisen

Kornowski²,

Vaduganathan³

et al. 2013

Cardiology

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Background: Retroperitoneal bleeding (RPB) is an unusual but potentially fatal vascular complication occurring after cardiac catheterization (CC). Contemporary data of RPB in the era of dual antiplatelet therapy and vascular closure devices are lacking. Methods: We retrospectively examined all RPB cases that occurred after CC in the Rabin Medical Center between the years 2005 and 2011. Results: Of 26,487 patients who underwent CC, a total of 48 patients (mean age 60.9 ± 13.8 years, 52.1% female) with RPB were identified (0.18%). The indication for CC was acute coronary syndrome (43.7%), myocardial infarction (35.4%), stable angina pectoris (8.3%), hemodynamic studies for valvular heart disease (10.4%) and others (2.1%). Coronary intervention was performed in 34 patients (70.9%) and a vascular closure device (VCD) was used in 16 patients (33.3%). Seventy-seven percent of patients were treated with clopidogrel, 20.8% with glycoprotein IIb-IIIa inhibitors and 85.4% with anticoagulation during CC. Median time to diagnosis of bleeding was 9.0 h, while the median time to bleeding differed between patients with and without a VCD (12 vs. 5 h, respectively). The clinical presentation of RPB was hemorrhagic shock in 39.6% of patients and 50.0% required at least one blood transfusion. Patients were managed either with conservative treatment (79.2%), angiography stenting (14.6%) or vascular surgery (6.2%). A total of 3 patients died during hospitalization, of which RPB was the etiology in 2 (4.2%). Conclusions: RPB which is a rare complication of CC is associated with younger age and female gender, ascompared to patients without RPB. Onset of bleeding can be delayed in patients with VCDs. With careful and early diagnosis, most patients with RPB after CC can be managed conservatively.

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“…All of them have ineludible harmful effects. Secondary consequences include discontinuation of antithrombotic therapy, which places the patient at an increased risk of recurrent ischemic events [17], and blood transfusions with proven detrimental effects [18]. …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes

et al. 2017

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Background: Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease. Methods: We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m². Results: The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, p = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, p = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all p values >0.3). Conclusions: The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.

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Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions

Cited by 494 publications

References 23 publications

Gastrointestinal Bleeding after Percutaneous Coronary Intervention

Gastrointestinal Bleeding after Percutaneous Coronary Intervention

Retroperitoneal Bleeding after Cardiac Catheterization: A 7-Year Descriptive Single-Center Experience

Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes

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