Pre-Procedural Estimate of Individualized Bleeding Risk Impacts Physicians' Utilization of Bivalirudin During Percutaneous Coronary Intervention

Abstract

There was an increase in bivalirudin use and a lower incidence of bleeding after the incorporation of individualized bleeding risk estimates into clinical practice. This implementation led to a reversal of the risk-treatment paradox, through a rational increase in bivalirudin use in patients at intermediate and high bleeding risk and decreased use in lower-risk patients.

Sources of Hospital-Level Variation in Major Bleeding Among Patients With Non–ST-Segment Elevation Myocardial Infarction

“…Furthermore, knowing the patients' bleeding risk can impact physician behavior in terms of treatment used. 23 Although we did not examine the relationship between individual bleeding risk profile and treatment selection with our current study design, we found that these factors together explained 32.3% hospital variation in major bleeding rates. Therefore, defining optimal treatment selection based on risk factors might be a critical step to motivate appropriate use of antithrombotic treatments and further reduce bleeding complications.…”

Mechanisms by Which Transradial Approach May Reduce Mortality in ST-Segment–Elevation Myocardial Infarction

“…2 Periprocedural bleeding is not benign because data have shown an association between bleeding complications and morbidity and mortality. [17][18][19][20][21] For example, using the National Cardiovascular Data Registry CathPCI Registry, Rao et al 22 demonstrated a >30% increase in 30-day mortality in patients with PCI-related bleeding. When compared with TFI, TRI has consistently been shown to reduce access site bleeding (Figure 2), major vascular complications, and blood transfusions.…”

Real-Time Decision Support to Guide Percutaneous Coronary Intervention Bleeding Avoidance Strategies Effectively Changes Practice Patterns

“…These changes in bivalirudin use were associated with reductions in bleeding complications in intermediate and high bleeding risk patients without increasing bleeding in low bleeding risk patients. 27 The current study is distinct in several ways. First, we used a shared electronic medical record to review all PCI cases from 3 distinct, independent, high-volume centers.…”

“…3 To our knowledge, only 1 previous study has used the NCDR bleeding risk model for pre-PCI risk stratification. Rao et al 27 found that individualized bleeding risk estimates increased bivalirudin use in intermediate and high bleeding risk patients and decreased bivalirudin use in low bleeding risk patients. These changes in bivalirudin use were associated with reductions in bleeding complications in intermediate and high bleeding risk patients without increasing bleeding in low bleeding risk patients.…”