News | Antiplatelet and Anticoagulation Therapies | May 06, 2016

National Hospital System Uses Enterprise Approach to Assess PCI Bleeding Risks

Study uses National Cardiovascular Data Registry bleeding risk calculator to determine appropriateness of bivalirudin to prevent clotting

SCAI 2016, PCI, bleeding risk, bivalirudin, NCDR risk calculator, clinical trial

May 6, 2016 — The largest risk-directed study by a national hospital system demonstrates a 40 percent decline in bleeding events for percutaneous coronary intervention (PCI) patients and a significant reduction in pharmacy costs. This quality improvement project (QIP) study was presented as a late-breaking clinical trial at the Society for Cardiovascular Angiography and Interventions (SCAI) 2016 Scientific Sessions, May 4-7 in Orlando, Fla.

PCI opens narrow or blocked coronary arteries. While it is a common non-surgical procedure, PCI-related bleeding can result in substantial morbidity and mortality. The QIP study aimed to reduce these bleeding events by using the National Cardiovascular Data Registry (NCDR) bleeding risk calculator and applying it to evidence-based bleeding avoidance strategies, including bivalirudin use.

“We found that some centers were using bivalirudin 100 percent of the time and others were not using it at all,” said Jerome E. Granato, M.D., vice president and medical director, National Cardiovascular Service Line at Catholic Health Initiatives, and the study’s lead author. “Our goal was to determine the most appropriate time to use bivalirudin, which is why the bleeding risk calculator was so vital.”

The two-year study (2013-2015) involved 8,713 PCI procedures from 21 hospitals in 11 states with more than 200 operators. The baseline Q1 2013 risk-adjusted bleeding event rate was 6.3 percent. Researchers used the bleeding risk calculator (Q2 2014) during the intra-procedural “time-out” and, based on the score, divided patients into high, intermediate or low bleeding risk groups. Depending on the risk assessment, access site and anticoagulant use, other interventions were used at the discretion of the operator.

Over the two-year period, incidence of bleeding decreased by 40 percent (6.3 percent to 3.78 percent). In addition, the cost of bleeding complications — typically about $8,000 per patient — was reduced by approximately $1 million for the entire hospital system.

Further, data showed that when physicians conducted the bleeding risk assessment before the procedure, they not only changed the use of the drug, they also adjusted their approach, going through the wrist instead of the groin with high-risk patients. 

Researchers monitored compliance by recording patients who received bivalirudin, their risk calculator scores and the percentage who fell into each risk category. That information was relayed back to the hospitals and resulted in greater adherence to the process.

“Our results showed that in a very large patient population and an expansive health system, we were able to change behaviors that resulted in better patient care and significant financial savings,” noted Granato. “We believe this process could easily be adopted by other health systems.”

The authors reported no disclosures. Catholic Health Initiatives has received an unrestricted educational grant from the Medicines Company.

For more information: www.scai.org

Related Content

Experimental Vaccine May Reduce Post-Stroke Blood Clot Risk
News | Antiplatelet and Anticoagulation Therapies | November 01, 2018
A vaccine may one day be able to replace oral blood thinners to reduce the risk of secondary strokes caused by blood...
Thrombolytic Science Initiates Phase 2 Trial of Novel Ischemic Stroke Treatment Regimen
News | Antiplatelet and Anticoagulation Therapies | September 07, 2018
A new Phase 2 clinical trial looks to confirm the efficacy and safety of Thrombolytic Science LLC’s (TSI) sequential...
Bleeds and Benefit With Aspirin Balanced in Diabetes Patients
News | Antiplatelet and Anticoagulation Therapies | September 05, 2018
Aspirin prevented serious vascular events in patients with diabetes who did not already have cardiovascular disease,...
Extended Post-Hospital Oral Anticoagulant Use Reduces Non-Fatal Blood Clots
News | Antiplatelet and Anticoagulation Therapies | August 31, 2018
Use of an oral anticoagulant in medically ill patients for 45 days following hospital discharge reduces the rate of non...
AFib Patients Want More Information About Anticoagulation Reversal
News | Antiplatelet and Anticoagulation Therapies | June 27, 2018
Results from a 902-person, five-country survey of people living with atrial fibrillation (AF) reinforce the importance...
Lower Oral DOAC Anticoagulant Use Associated With More Thromboembolic Events Than Warfarin. #HRS 2018
News | Antiplatelet and Anticoagulation Therapies | May 18, 2018
May 18, 2018 — Nearly half of patients prescribed warfarin and just under one third of those using newer direct oral
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated for patients treated with rivaroxaban (Xarelto) and apixaban (Eliquis), when reversal of anticoagulation is needed due to life-threatening or uncontrolled bleeding.

 

Feature | Antiplatelet and Anticoagulation Therapies | May 07, 2018
The U.S. Food and Drug Administration (FDA) has approved Portola Pharmaceuticals' Andexxa, the first antidote indicated...
The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association. #ACC18

The largest trial to date for short-term DAPT concluded the practice cannot be deemed safe due to a higher adverse event rate. Image courtesy of the American Heart Association.

News | Antiplatelet and Anticoagulation Therapies | March 19, 2018
The combined rate of death from any cause, heart attack or stroke within 18 months was not significantly different in...
The Xarelto booth at ACC.18

The Xarelto booth at the 2018 American College of Cardiology meeting. 

News | Antiplatelet and Anticoagulation Therapies | March 14, 2018
March 14, 2018 — A late-breaking analysis of the landmark COMPASS study presented at the American College of Cardiolo
Overlay Init