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Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry.

Publication ,  Journal Article
Baklanov, DV; Kim, S; Marso, SP; Subherwal, S; Rao, SV
Published in: Circ Cardiovasc Interv
August 2013

BACKGROUND: Bleeding is a common, noncardiac, preventable complication of percutaneous coronary intervention. We compared the relative safety of radial access and bivalirudin in percutaneous coronary intervention. METHODS AND RESULTS: From CathPCI Registry, we determined the association between the site of arterial access, bivalirudin, and periprocedural bleeding rates in 501 017 patients. Radial access patients receiving heparin (radial group) were compared with those receiving bivalirudin (radial combination group). Femoral access patients who had bivalirudin and a vascular closure device served as a reference group (femoral group). An inverse probability weighting analysis incorporating propensity scores was used to compare groups. The overall rate of bleeding was 2.59%. It was 2.71% in the femoral group, 2.5% in the radial group, and 1.82% in the radial combination groups (P<0.001). When compared with femoral group, the adjusted odds ratio for bleeding was significantly lower for patients with radial combination group (odds ratio, 0.79; 95% confidence interval, 0.72-0.86), but not for radial group (odds ratio, 0.96; 95% confidence interval, 0.88-1.05), unless patients treated with IIb/IIIa were excluded (radial group-IIb/IIIa odds ratio, 0.84; 95% confidence interval, 0.75-0.94).The number needed to treat to prevent 1 bleeding event with radial combination group was 138, whereas the number needed to treat to prevent 1 bleeding event in high-bleeding risk patients was 68. CONCLUSIONS: In this observational analysis, the combination of bivalirudin and radial access was associated with reduced bleeding event rate. This benefit was present across the entire spectrum of preprocedural risk of bleeding, with or without exposure to IIb/IIIa inhibitors. These data support an adequately powered randomized trial comparing bleeding avoidance strategies.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

August 2013

Volume

6

Issue

4

Start / End Page

347 / 353

Location

United States

Related Subject Headings

  • Risk
  • Registries
  • Recombinant Proteins
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Peptide Fragments
  • Middle Aged
  • Male
  • Humans
  • Hirudins
 

Citation

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Baklanov, D. V., Kim, S., Marso, S. P., Subherwal, S., & Rao, S. V. (2013). Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry. Circ Cardiovasc Interv, 6(4), 347–353. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000279
Baklanov, Dmitri V., Sunghee Kim, Steven P. Marso, Sumeet Subherwal, and Sunil V. Rao. “Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry.Circ Cardiovasc Interv 6, no. 4 (August 2013): 347–53. https://doi.org/10.1161/CIRCINTERVENTIONS.113.000279.
Baklanov, Dmitri V., et al. “Comparison of bivalirudin and radial access across a spectrum of preprocedural risk of bleeding in percutaneous coronary intervention: analysis from the national cardiovascular data registry.Circ Cardiovasc Interv, vol. 6, no. 4, Aug. 2013, pp. 347–53. Pubmed, doi:10.1161/CIRCINTERVENTIONS.113.000279.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

August 2013

Volume

6

Issue

4

Start / End Page

347 / 353

Location

United States

Related Subject Headings

  • Risk
  • Registries
  • Recombinant Proteins
  • Radial Artery
  • Percutaneous Coronary Intervention
  • Peptide Fragments
  • Middle Aged
  • Male
  • Humans
  • Hirudins