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Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry.

Publication ,  Journal Article
Bhardwaj, B; Spertus, JA; Kennedy, KF; Jones, WS; Safley, D; Tsai, TT; Aronow, HD; Vora, AN; Pokharel, Y; Kumar, A; Attaran, RR; Feldman, DN ...
Published in: JACC Cardiovasc Interv
June 24, 2019

OBJECTIVES: This study sought to assess periprocedural bleeding complications in lower-extremity peripheral vascular interventions (PVIs). BACKGROUND: Few studies have examined the incidence, predictors, or outcomes of periprocedural bleeding after lower-extremity PVI. METHODS: The study examined patients undergoing PVI at 76 hospitals in the National Cardiovascular Data Registry PVI registry from 2014 to 2016. Post-PVI major bleeding was defined as any overt bleeding with a hemoglobin (Hb) drop of ≥3 g/dl, any Hb decline of ≥4 g/dl, or blood transfusion in patients with pre-procedure Hb >8 g/dl within 72 h of their procedure. Hierarchical multivariable logistic regression was used to identify factors independently associated with post-PVI bleeding. The study also examined adjusted in-hospital mortality among patients with or without major bleeding complications. RESULTS: Among 18,289 PVI procedures, major bleeding occurred in 744 (4.10%). Patient characteristics independently associated with bleeding included age, female sex, heart failure, pre-procedural hemoglobin <12 g/dl, nonelective PVI, and critical limb ischemia on presentation. Procedural characteristics associated with bleeding included nonfemoral vascular access, use of thrombolytic therapy, PVI of the aortoiliac segment, and multilesion interventions, whereas use of closure devices was associated with less bleeding. All-cause in-hospital mortality was higher in patients who experienced bleeding than in those who did not (6.60% vs. 0.30%; p < 0.001; adjusted hazard ratio: 10.9; 95% confidence interval: 6.9 to 17.0). CONCLUSIONS: Major bleeding occurred in 4.10% of lower-extremity PVI procedures and was associated with several patient and procedural characteristics, as well as in-hospital mortality. These insights can be incorporated into strategies to reduce periprocedural bleeding after PVI.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 24, 2019

Volume

12

Issue

12

Start / End Page

1140 / 1149

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Peripheral Vascular Diseases
  • Middle Aged
  • Male
  • Lower Extremity
 

Citation

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Bhardwaj, B., Spertus, J. A., Kennedy, K. F., Jones, W. S., Safley, D., Tsai, T. T., … Salisbury, A. C. (2019). Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry. JACC Cardiovasc Interv, 12(12), 1140–1149. https://doi.org/10.1016/j.jcin.2019.03.012
Bhardwaj, Bhaskar, John A. Spertus, Kevin F. Kennedy, W Schuyler Jones, David Safley, Thomas T. Tsai, Herbert D. Aronow, et al. “Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry.JACC Cardiovasc Interv 12, no. 12 (June 24, 2019): 1140–49. https://doi.org/10.1016/j.jcin.2019.03.012.
Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safley D, Tsai TT, et al. Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry. JACC Cardiovasc Interv. 2019 Jun 24;12(12):1140–9.
Bhardwaj, Bhaskar, et al. “Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry.JACC Cardiovasc Interv, vol. 12, no. 12, June 2019, pp. 1140–49. Pubmed, doi:10.1016/j.jcin.2019.03.012.
Bhardwaj B, Spertus JA, Kennedy KF, Jones WS, Safley D, Tsai TT, Aronow HD, Vora AN, Pokharel Y, Kumar A, Attaran RR, Feldman DN, Armstrong E, Prasad A, Gray B, Salisbury AC. Bleeding Complications in Lower-Extremity Peripheral Vascular Interventions: Insights From the NCDR PVI Registry. JACC Cardiovasc Interv. 2019 Jun 24;12(12):1140–1149.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

June 24, 2019

Volume

12

Issue

12

Start / End Page

1140 / 1149

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Registries
  • Peripheral Vascular Diseases
  • Middle Aged
  • Male
  • Lower Extremity