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ANTICOAGULATION

Percutaneous Coronary Intervention-Related Bleeding Risk Factors in Current Practice

¹ Clinical Associate Professor, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ; Clinical Assistant Director, Department of Pharmacy, Saint Barnabas Medical Center, Livingston, NJ
² Student, Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey

Reprints: Dr. Mathis, Department of Pharmacy, Saint Barnabas Medical Center, 94 Old Short Hills Rd., Livingston, NJ 07039-5672, fax 973/322-5185, smathis{at}rci.rutgers.edu

BACKGROUND: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Little is known about the risk factors for bleeding complications.

OBJECTIVE: To report our PCI-related observations from a single institution and use the information to establish risk factors for short-term bleeding complications, with special focus on examining the importance of renal function.

METHODS: A retrospective record review was conducted of the admission of 300 patients grouped according to antithrombotic regimen: unfractionated heparin alone (n = 187), bivalirudin (n = 26), and glycoprotein IIb/IIIa antagonist plus heparin (n = 103). Bleeding and ischemic outcomes were tracked. A model was constructed to predict independent bleeding risk factors.

RESULTS: Treatment groups differed significantly regarding any bleeding (p = 0.001), minor bleeding (p < 0.001), and length of stay (p = 0.01). Multivariate predictors of any bleeding included antithrombotic regimen, creatinine clearance (Cl_cr) <30 mL/min, and hypertension. Any bleeding was associated with prolonged length of stay. Major bleeding was predicted by Cl_cr <30 mL/min and was associated with prolonged length of stay and death. Minor bleeding was predicted only by choice of antithrombotic regimen.

CONCLUSIONS: The major influences on bleeding risk appeared to be Cl_cr <30 mL/min and choice of antithrombotic regimen. It is important to note that other markers of renal function, including serum creatinine value and serum creatinine at a cutoff level of 1.5 mg/dL, did not predict bleeding events.

Key Words: bivalirudin, glycoprotein IIb/IIIa antagonist, heparin

Published Online, September 6, 2005. www.theannals.com, DOI 10.1345/aph.1G057