{"id":1648,"date":"2015-05-05T15:09:10","date_gmt":"2015-05-05T14:09:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1648"},"modified":"2015-11-12T17:07:29","modified_gmt":"2015-11-12T16:07:29","slug":"precision-medicine-to-reduce-bleeding-with-pci","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2015\/05\/05\/precision-medicine-to-reduce-bleeding-with-pci\/","title":{"rendered":"Precision Medicine to\u00a0Reduce\u00a0Bleeding\u00a0with\u00a0PCI\u00a0 \u00a0"},"content":{"rendered":"

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Periprocedural\u00a0bleeding remains one of the most common adverse events after percutaneous coronary intervention (PCI) and is associated with\u00a0increased\u00a0mortality.\u00a0\u00a0Although\u00a0strategies to minimize\u00a0PCI\u00a0bleeding have been identified,\u00a0these strategies\u00a0are infrequently applied to patients at highest\u00a0bleeding\u00a0risk.\u00a0 Using a pre-post study design,\u00a0Spertus\u00a0et al.\u00a0evaluated the impact of assessing individual patient bleeding risk from validated models and providing this\u00a0bleeding risk\u00a0estimate in personalized informed consent documents\u00a0for\u00a0PCI.\u00a0 The\u00a0intent of the intervention was to increase the\u00a0procedural team\u2019s awareness of patients at low, moderate, and risk for\u00a0PCI related\u00a0bleeding\u00a0and thereby influence the use\u00a0of bleeding avoidance strategies\u00a0(i.e.\u00a0bivalirudin, radial access, and vascular closure devices)\u00a0and\u00a0reduce\u00a0periprocedural\u00a0bleeding\u00a0events.\u00a0\u00a0The study included 7408 pre-intervention PCI and 3529 post-intervention PCI from 9 hospitals in the United States.\u00a0Following implementation\u00a0of the intervention, use of bleeding avoidance strategies increased (odds ratio for use of bleeding avoidance strategies: 1.81, 95%\u00a0confidence interval 1.44-2.27), especially\u00a0among higher risk individuals (OR 2.03, 95% CI 1.58-2.61).\u00a0 Furthermore, bleeding rates\u00a0were lower following implementation of the intervention (1.0 v. 1.7%, OR 0.62, 95% CI 0.44 to 0.87 after adjustment\u00a0for contemporary trends).\u00a0\u00a0Following the\u00a0intervention, significant variation remained both between and within hospitals with regards to\u00a0use of bleeding avoidance strategies.<\/p>\n

Conclusion:<\/b>\u00a0Providing clinicians with individual\u00a0patient\u00a0bleeding risks immediately prior to PCI\u00a0was associated with\u00a0increased and targeted use of bleeding avoidance strategies and lower risk-adjusted bleeding rates.\u00a0 However,\u00a0significant variability in\u00a0the approach to bleeding avoidance persisted after implementation of this tool.<\/p>\n

Summarized by Javier A. Valle and Steven M. Bradley<\/p>\n