Non-access site bleeding is a stronger predictor of mortality than access site bleeding

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Gjin Ndrepepa (Deutsches Herzzentrum München, Technische Universität, Munchen, Germany) and others reported in Circulation: Cardiovascular Interventions that non-access site bleeding after percutaneous coronary intervention (PCI) is a stronger predictor of mortality than is access site bleeding and it improves the discriminatory power of models for mortality prediction. 

Ndrepepa et al commented that “little is known” about the relationship between site of bleeding and clinical outcome and that the purpose of their study was to, using the Bleeding Academic Research Consortium (BARC) criteria, evaluate bleeding events after PCI with three objectives. These objectives were assessing the association between access site and non-access site bleeding within the first 30 days after PCI and mortality; investigating factors associated with access site and non-access site bleeding; and investigating whether bleeding events of different locations improved the discriminatory power of the multivariate models on mortality prediction.


In a pooled patient-level analysis of 14,180 patients from seven randomised controlled trials, the authors found that 1,510 patients had a bleeding event within 30 days of undergoing a PCI procedure. Of these, 905 had access site bleeding and 605 had non-access bleeding. Ndrepepa et al noted that 120 patients with non-access site bleeding also had access site bleeding.


They reported: “Access site and non-access site bleeding were each independently associated with an increased risk of one-year mortality, showing a 1.72- and 2.78-fold increase in the adjusted risk for mortality, respectively, compared with patients who did not bleed. The adjusted risk of mortality associated with non-access site bleeding was 62% higher than the adjusted risk for mortality associated with access site bleeding.” The authors added that the inclusion of access site bleeding into a mortality prediction model did not significantly improve the discriminatory power of the model (p=0.084). However, they said that the inclusion of non-access site bleeding into the model was associated “with a significant increase of the discriminatory power of the model on predictor of mortality compared with the model without bleeding (p=0.031).”


Another important finding in the study, Ndrepepa et al stated, was that patients with non-access site bleeding had a “more adverse cardiovascular risk profile” than the patients with access site bleeding even though they shared similar predisposing factors.


Study author Adnan Kastrati, Deutsches Herzzentrum München, Technische Universität, Munchen, Germany, told Cardiovascular News: “Although radial access may reduce the risk of access site bleeding, reduction of the prognostically more relevant form of bleeding, non-access site bleeding, may require a broader use of antithrombotic drugs with bleeding reducing properties such as bivalirudin. Special medical attention should be reserved to certain categories of patients with excess risk of non-access site bleeding such as older patients, women, patients with small body mass index and those with chronic kidney disease.”

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