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Combination Strategy Best for Bleeding Prevention After PCI

But those in high preprocedural bleeding risk category less likely to get this strategy

TUESDAY, June 1 (HealthDay News) -- Patients undergoing percutaneous coronary intervention (PCI) who get bivalirudin in addition to a vascular closure device have the lowest bleeding risk, but patients with a high preprocedural bleeding risk are less likely to receive this treatment, according to research published in the June 2 issue of the Journal of the American Medical Association.

Steven P. Marso, M.D., of Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues analyzed data from 1,522,935 patients from a cardiovascular data registry undergoing PCI from 2004 to 2008. The main measured outcome was periprocedural bleeding.

Three methods of bleeding prevention were used in varying proportions of patients: manual compression (35 percent), vascular closure devices (24 percent), bivalirudin (23 percent), or closure devices and bivalirudin combined (18 percent). The researchers found that 2 percent of patients had periprocedural bleeding; this risk was highest in those receiving manual compression and lowest in those receiving a combination of a closure device and bivalirudin (2.8 versus 0.9 percent). Those in a higher preprocedural bleeding risk category (using a standardized assessment model) did have higher rates of postprocedural bleeding, and were significantly less likely to have been treated with the more effective vascular closure plus bivalirudin strategy.

"This apparent risk-treatment paradox highlights an opportunity for routine preprocedural risk stratification as a means to identify patients ideally suited for individualized bleeding avoidance strategies with the goal of increasing the safety of PCI," the authors write.

Several authors disclosed financial relationships with pharmaceutical and medical device companies.

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