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Periprocedural bleeding in patients undergoing percutaneous coronary intervention

INTRODUCTION

The advent of aggressive, multidrug antithrombotic therapy during percutaneous coronary intervention (PCI) has led to significant reductions in short- and long-term ischemic outcomes. (See "Antithrombotic therapy for percutaneous coronary intervention: General use".)

Periprocedural bleeding is a frequent complication of PCI, and its frequency and severity is related in part to the intensity of antithrombotic therapy. Initially, periprocedural bleeding was viewed as a relatively benign consequence, but data have linked the occurrence of bleeding and its treatment (ie, blood transfusion) to increased mortality and other adverse clinical outcomes.

This topic reviews most aspects of periprocedural bleeding among patients undergoing PCI. Gastrointestinal bleeding in this setting is discussed separately. (See "Periprocedural and long-term gastrointestinal bleeding in patients undergoing percutaneous coronary intervention".)

Bleeding in relation to coronary artery bypass grafting or in association with diagnostic coronary angiography is discussed elsewhere. (See "Early noncardiac complications of coronary artery bypass graft surgery", section on 'Bleeding' and "Complications of diagnostic cardiac catheterization", section on 'Local vascular complications'.)

DEFINITION

Estimates of the incidence of periprocedural bleeding during percutaneous coronary intervention (PCI) lack precision due to the use of different definitions. In addition, relevant data come from differing patient populations who were treated with varying regimens of adjunctive pharmacology. Early studies of adjunctive pharmacology in PCI utilized definitions that were extrapolated from fibrinolytic trials (such as the TIMI and GUSTO scales). These early definitions focused on occurrence of intracranial bleeds or large drops in hemoglobin [1]. In more studies, the definitions of major bleeding have been more inclusive of less severe, but clinically significant, bleeds (table 1).

                          

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Literature review current through: Sep 2014. | This topic last updated: Mar 20, 2014.
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