Steps to Prevent Bleeding After PCI Have Particular Impact in Women

April 10, 2013

By David Douglas

NEW YORK (Reuters Health) Apr 10 - Women are more likely to bleed after percutaneous coronary intervention (PCI), and a new study shows they also get a greater absolute risk reduction from use of vascular closure devices, bivalirudin, a radial approach, or a combination of these.

These bleeding avoidance strategies "were similarly effective at reducing bleeding in women and men" in the study, Dr. Stacie L. Daugherty told Reuters Health by email. "Importantly, due to higher rates of bleeding in women following PCI, the absolute reductions in bleeding risk were almost two times higher in women compared with men for all bleeding avoidance strategy types."

Dr. Daugherty of the University of Colorado School of Medicine, Aurora and colleagues reported their findings March 21st online in the Journal of the American College of Cardiology.

The researchers studied national registry data on more than 385,000 men and more than 185,000 women who had PCI between 2009 and 2011. Bleeding avoidance strategies (BAS) were used slightly but significantly less often in women than men (75.4% vs 75.7%).

When BAS were used, both genders had similar reductions in the risk of bleeding, with adjusted odds ratios of 0.60 for women and 0.62 for men.

As has been reported before, without BAS, women had a much higher bleeding rate (12.5% vs 6.2%). With BAS, both genders had lower absolute bleeding risks - but the risk was reduced by 6.3% in women vs 3.2% in men.

Overall, each BAS strategy studied was associated with similarly lower relative risks of bleeding in women and men compared with the use of no BAS. There was, however, an apparently slightly greater benefit of the combined use of the transradial approach and bivalirudin in women; this combination was linked to a 69% reduction in bleeding in women and a 54.0% reduction in men. The numbers were small, however.

The researchers also saw a "risk treatment paradox." In both genders, patients at highest risk for bleeding were least likely to receive BAS - a finding that needs to be investigated, they say.

Taken together, say the investigators, the results suggest "that persistent gender differences in bleeding post-PCI are not due to differences in the apparent effectiveness of BAS."

Dr. Daugherty adds that the findings also "underscore the importance of using bleeding avoidance strategies in women undergoing PCI."

Commenting on the findings by email, Dr. Morten Lamberts of Copenhagen University Hospital Gentofte, Hellerup, Denmark, who has studied bleeding after PCI, noted, "Although the authors confirm findings of a larger burden of cardiovascular disease in women when undergoing PCI and also that female gender per se is a risk factor of bleeding, the authors find BAS lowers bleeding in a similar manner in both men and women. Inherent in the observational study design are several limitations and extrapolating findings to clinical practice concerning BAS use should be done very cautiously, if at all."

"However," Dr. Lamberts added, "two important observations come to mind. First, a high crude rate of bleeding among women must raise concerns for clinicians. Second, the study adds important contemporary knowledge of bleeding hazards, but future studies of bleeding risk factors and bleeding complications in patients with coronary artery disease treated with PCI and/or antithrombotic measures are warranted."


J Am Coll Cardiol 2013.