Access and Anticoagulation Strategies to Reduce Bleeding Risk During PCI

Strategies for reducing bleeding complications of percutaneous coronary intervention (PCI) include radial access and use of the direct thrombin inhibitor bivalirudin and of femoral vascular closure devices. These investigators used data from the CathPCI registry of the National Cardiovascular Data Registry to assess radial access with heparin or bivalirudin as compared with femoral access with bivalirudin and a closure device. The study population, 501,017 patients who underwent PCI from July 2009 through March 2012, represented less than one third of all PCIs recorded during that time. Most participants had femoral access (76%).

The overall rate of bleeding during or within 72 hours after PCI was 2.7% in the femoral-access group, 2.5% in the radial-access group with heparin, and 1.8% in the radial-access group with bivalirudin (P<0.001). Most bleeding events were non–access-site-related — 2.1%, 2.2%, and 1.6% in the femoral-access, radial-heparin, and radial-bivalirudin groups, respectively. Rates of in-hospital death, stroke, and myocardial infarction did not differ significantly among the three groups. In a propensity analysis accounting for baseline differences, bleeding risk did not differ significantly between the radial-heparin and femoral-bivalirudin-closure-device groups, but a significant benefit was found with radial access plus bivalirudin across all bleeding-risk subgroups.