Bleeding complications from large-bore catheter procedures common, linked to poor outcomes

WASHINGTON — According to a presentation at the American College of Cardiology Scientific Session, bleeding complications are typical after percutaneous transcatheter interventions that used large-bore catheters and are often associated with high mortality and morbidity.

“We sought to determine the incidence of bleeding complications among patients who underwent transcatheter interventions using large-bore catheters and study the association of bleeding complications with in-hospital mortality risk, length of stay, and overall health care cost,” Björn Redfors, MD, PhD, from Sahlgrenska University Hospital, Gothenburg, Sweden, and the Cardiovascular Research Foundation, and colleagues wrote in a simultaneous publication in JAMA Cardiology.

Using the Healthcare Cost and Utilization Project’s National Inpatient Sample database, Redfors and colleagues analyzed 17,672 patients who had undergone transcatheter aortic valve replacement (n = 3,223), endovascular aneurysm repair (n = 12,633), or implantation of a percutaneous left ventricular assist device (n = 1,816) with a large-bore catheter.

Researchers defined bleeding complication as any transfusion, hemorrhage or hematoma or a bleeding event that required percutaneous or surgical intervention.

Health care costs were determined by the total charge for each visit multiplied by the cost to charge ratios reported for each hospital code in the database.

Multivariable logistic regression was used to determine the adjusted relationship between bleeding complications and mortality.

Redfors and colleagues compared length of stay and total health care costs via a comparison using multivariable linear regression between those who did and did not have bleeding complications.

A total of 17.7% of patients (n = 3,128) experienced bleeding complications (1,984 men; mean age, 76 years).

The researchers found an association between bleeding and higher mortality (adjusted OR = 2.7; 95% CI, 2.27-3.22; P < .001) and longer hospital stay (adjusted multiplicative difference, 2.14; 95% CI, 2.06-2.16; P < .001).

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For patients with bleeding complications, median total cost of health care was $48,663 (interquartile range, 32,620-71,547) compared with $29,968 (interquartile range, 21,942-43,287) for patients who did not experience bleeding complications (adjusted multiplicative difference, 1.55; 95% CI, 1.52-1.59; P < .001).

“Of note, the mortality risk was relatively low for patients who underwent TAVR or EVAR and did not experience bleeding, but the risk increased dramatically if a bleeding complication occurred, particularly for patients who underwent EVAR,” Redfors and colleagues wrote. “Better preventive and bleeding avoidance strategies are needed if the full benefits of these new techniques are to be achieved.” – by Dave Quaile

Reference:

Redfors B, et al. Abstract 1192-127. Presented at: American College of Cardiology Scientific Session; March 17-19, 2017; Washington, D.C.

Redfors B, et al. JAMA Cardiol. 2017;doi:10.1001/jamacardio.2017.0265.

Disclosure: Redfors reports no relevant financial disclosures.