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Bleeding after endovascular PAD procedures portends bad outcomes
Among patients who had an endovascular procedure to treat peripheral artery disease, more than 4% had major bleeding, and those with major bleeding were at elevated risk for in-hospital mortality, researchers reported.
The study was the first one published from the National Cardiovascular Data Registry’s (NCDR) Peripheral Vascular Intervention Registry, according to a press release from the American College of Cardiology.
Bleeding frequency
“This is the first large-scale study to describe the frequency of bleeding in patients undergoing lower extremity peripheral vascular interventions,” Adam C. Salisbury, MD, MSc, a cardiologist with St. Luke’s Health System in Kansas City, Missouri, said in the release. “Bleeding has been well studied in coronary artery procedures but not in vascular procedures involving the lower extremities.”
Salisbury and colleagues analyzed 18,289 patients (mean age, 69 years; 40% women) who underwent peripheral vascular interventions at 76 centers included in the PVI Registry between 2014 and 2016.
Among the cohort, 4.1% had major bleeding, defined as any overt bleeding with a hemoglobin drop of at least 3 g/dL, any hemoglobin decline of at least 4 g/dL or blood transfusion in patients with preprocedural hemoglobin greater than 8 g/dL within 72 hours of their procedure.
The researchers identified the following characteristics associated with major bleeding: age, female sex, HF, preprocedural hemoglobin less than 12 g/dL, nonelective intervention, critical limb ischemia, nonfemoral vascular access, use of thrombolytic therapy, procedure in the aortoiliac segment and multi-lesion intervention, whereas use of closure devices was protective against major bleeding (P < .05 for all).
Patients with major bleeding had a more than 10-fold risk for in-hospital all-cause mortality compared with patients who did not have major bleeding (6.6% vs. 0.3%; adjusted HR = 10.9; 95% CI, 6.9-17), according to the researchers.
“The findings suggest we can use different procedural strategies, such as using different access points for the catheter, alternative blood thinners or different sizes of equipment, to reduce the risk of bleeding,” Salisbury said in release. “We can use the findings to identify factors and create models to predict who is at higher risk of bleeding. In these patients, we need to be especially careful to avoid doing anything that could increase the risk of bleeding.”
Starting point
In a related editorial, Douglas E. Drachman, MD, FACC, FSCAI, director of the cardiovascular and interventional cardiology fellowship programs at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, and Beau M. Hawkins, MD, interventional cardiologist at the University of Oklahoma Health Sciences Center, wrote: “The findings of this analysis represent a starting point from which modifiable bleeding risk factors during [peripheral vascular intervention] may be targeted to reduce complication rates. Moreover, as is often the case with studies examining procedural outcomes, the investigators’ discovery that there is substantial variation in bleeding outcomes across participating NCDR PVI Registry institutions indicates that there may be significant opportunity to establish and disseminate best treatment practices, in order to improve performance at those institutions found to have higher bleeding rates.” – by Erik Swain
Disclosures: Salisbury and Hawkins report no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures. Drachman reports he is a consultant for Abbott Vascular, Boston Scientific, Broadview Ventures, Cardiovascular Systems Inc. and Corindus Vascular Robotics; and has received research support from Atrium Medical and Lutonix/CR Bard.