Personalized Bleeding Risk Score to Optimize Post Coronary Intervention Outcomes

Friday, 28 July 2017

Sivaranjani Ramamoorthy, DNP, MSN
Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA

Purpose: To examine the effect of implementing a standardized bleeding risk score in minimizing bleeding complications in adult patients undergoing percutaneous coronary intervention

Background: Bleeding is the most common complication after percutaneous coronary Intervention (PCI). PCI–related bleeding events are associated with increased mortality, morbidity, cost and length of stay (LOS). Based on the Centers of Medicare and Medicaid Services Acute Care Episode Demonstration Program, PCI-related bleeding is considered a quality indicator for PCI outcome. According to 2011 AHA/ACC PCI guidelines, all the patients undergoing PCI need to be evaluated for their bleeding risk prior to the procedure. Personalized bleeding risk score (BRS) can predict and prevent PCI-related bleeding complications. The National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score (BRS) is a validated bleeding risk predictor tool which is readily available however, it is underutilized in the clinical setting.

Methods and Results: A quality improvement study was proposed and implemented in a cohort of sequential patients (n=128 electively scheduled for PCI. Retrospective data of patients who were reported to have had bleeding complications requiring blood transfusion and extended length of stay (LOS) were retrieved electronically. Then, an educational intervention was instituted to implement the BRS assessment tool and to use an expanded PCI-specific bleeding definition to document post-PCI bleeding. PCI-related bleeding complications, prior to initiation of the CathPCI bleeding risk tool (n=64) was compared to those who had pre-procedural estimation of bleeding risk (n=64) before undergoing PCI. Pre-procedural estimation of bleeding risk has had significantly (p=0.00) reduced the rate of PCI-related bleeding complications. The use of a bleeding risk tool supported clinician’s selection of the appropriate treatment modalities such as coronary artery bypass graft (CABG) vs. percutaneous coronary intervention vs. medical therapy; assisted in the selection of stent type, drug eluting vs. bare metal, helps in the choice of type and duration of antiplatelet therapy, aids in careful attainment of vascular access radial vs. femoral artery, and influenced the use of vascular closure device vs. manual compression to reduce a patient’s chances of developing bleeding complications.

Conclusion: Estimating pre procedural bleeding risk guides clinical decision making to promote bleeding risk adjusted therapy and which achieves better clinical outcomes. The study concluded that implementing the NCDR CathCPI bleeding risk score and using an expanded PCI specific bleeding definition together have effectively reduced the number of blood transfusions and length of stay.

Key Words: CathPCI Bleeding risk score; PCI Bleeding risk prediction; Personalized Bleeding risk Score