Major bleeding occurs in about 4 percent of peripheral vascular intervention (PVI) procedures, leading to an increased risk of in-hospital mortality, according to a study published June 17 in JACC: Cardiovascular Interventions. The study is the first published research using data from ACC’s PVI Registry.

Bhaskar Bhardwaj, MD, et al., used the PVI Registry data to analyze 18,289 PVI patients at 76 hospitals to assess major bleeding within 72 hours of the procedure. The researchers also looked at in-hospital mortality among patients with and without major bleeding and characteristics independently associated with post-PVI bleeding. Major bleeding was defined as hemoglobin drop of ≥3 g/dl, any hemoglobin decline ≥4 g/dl, or the need for a blood transfusion in patients with preprocedure hemoglobin of >8 g/dl.

According to the results, major bleeding occurred in 744 patients (4.1 percent). The in-hospital mortality rate was higher among patients with major bleeding at 6.6 percent vs. 0.3 percent among patients without major bleeding. Women, older patients, and those with heart failure or anemia were more likely to experience major bleeding. In addition, major bleeding was more common with nonfemoral vascular access and the use of thrombolytic therapy.

The study demonstrates that post-PVI bleeding is “strongly associated with in-hospital mortality,” the researchers conclude, adding that additional research “is needed to develop strategies that would maximize the safety of PVI.”

In an accompanying editorial comment, Douglas E. Drachman, MD, FACC, and Beau M. Hawkins, MD, FACC, write that the study establishes that bleeding is a “common complication” of PVI and “confers significant clinical risk.” They conclude that the study “represents an opportunity to establish best practices and improve patient outcomes.”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Hospital Mortality, Hemoglobins, Blood Transfusion, Registries, Heart Failure, Thrombolytic Therapy, National Cardiovascular Data Registries, PVI Registry

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