Minimising bleeding during percutaneous coronary intervention

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1395 (Published 24 March 2015) Cite this as: BMJ 2015;350:h1395
  1. Gjin Ndrepepa, senior research scientist,
  2. Adnan Kastrati, professor of cardiology
  1. 1German Heart Centre, Technical University of Munich, Germany
  1. Correspondence to: G Ndrepepa, Deutsches Herzzentrum München, Lazarettstrasse 36, 80636 München, Germany ndrepepa{at}dhm.mhn.de

Identify high risk patients likely to benefit from bleeding avoidance strategies

In 2013 more than 92 500 percutaneous coronary intervention (PCI) procedures were performed in the United Kingdom alone.1 Bleeding events are among the most common complications; reported incidences vary between 2.2% and 14%.2 Peri-procedural bleeding has a negative effect on patients’ outcomes—as indicated by higher mortality and morbidity and diminished quality of life—and on metrics of healthcare provision such as length of stay and associated costs.3 Large registries of US patients undergoing PCI have shown that 12.1% of in-hospital mortality is attributable to post-procedural bleeding and suggest a significant association between major bleeding and in-hospital mortality across all strata of bleeding risk.4 The 2011 American Heart Association guidelines state that all patients should be evaluated for risk of bleeding before PCI (class of recommendation 1, level of evidence C).5

In a linked paper (doi:10.1136/bmj.h1302), Spertus and colleagues report findings from a prospective cohort study designed to investigate whether prospective assessment of bleeding risk has any effect on use of bleeding avoidance strategies or subsequent bleeding rates in patients undergoing PCI.6 Bleeding avoidance strategies investigated in …

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