Post-PCI bleeding reduced with changes in strategy

Changes in procedural antithrombotic strategy are associated with a significant temporal reduction in major bleeding over time in patients undergoing elective post-percutaneous intervention (PCI), according to a study published in the Journal of the American College of Cardiology. 

Researchers from Duke Clinical Research Institute who analyzed the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry found an approximate 20% reduction in PCI bleeding from 2005 to 2009 among patients with elective PCI, unstable angina/non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction (STEMI).

The researchers used data from the ACC NCDR, which included 1.7 million patient admissions for PCI at more than 1,000 sites from 2005 to 2009.

“This has coincided with a national uptake in use of bivalirudin [from 17% to 30% in the study period] and reduction in use of heparin plus glycoprotein IIb/IIIa [from 41% to 28% over the study period] as an antithrombotic strategy for percutaneous coronary intervention,” lead author Sumeet Subherwal, MD, MBA, told Drug Topics.

“After adjusting for patient characteristics known to be associated with bleeding, we found there remained a significant 6% to 8% per year reduction in annual bleeding risk in the unstable angina/non-ST-segment elevation myocardial infarction and elective percutaneous coronary intervention patients who underwent PCI,” Subherwal added.

The researchers found that changes in antithrombotic strategies over the study period (uptake in use of bivalirudin and decrease in use of heparin plus glycoprotein IIb/IIIa strategy) contributed to nearly half of this annual reduction in bleeding risk.

Meanwhile, the use of other bleeding avoidance strategies, such as radial artery access and use of vascular closure devices were much less associated with this temporal reduction in bleeding. 

According to Subherwal, the present analysis of more than 1 million real-world patients who underwent PCI demonstrates that “as a profession, we are increasingly adopting use of bleeding avoidance strategies to minimize complications of bleeding among patients undergoing PCI.

“Importantly, these strategies have led to a modest but significant reduction in bleeding rates from 2005 to 2009. It remains to be seen what the effect of further adoption of bleeding avoidance strategies, and changing landscape of antithrombotic therapies will have on future bleeding rates,” he said.