The Investigation of Bleeding Complications Following Cardiovascular Intervention

Following advances in device technology and adjunctive pharmacotherapy, percutaneous cardiac interventions are presently indicated to treat a broad and complex range of cardiovascular pathology, including in high risk patients. The proportion of patients living with cardiovascular disease receiving antithrombotic medications for secondary prevention has increased. These factors bear significant impact on the rate of complications in this population, including periprocedural and long-term bleeding complications. The overall aim was to explore the correlates and modifiers of bleeding events in this population. In a retrospective cohort study of balloon aortic valvuloplasty, intraprocedural Bivalirudin was independently associated with reduced in-hospital major bleeding compared with heparin (OR, 0.37, 95% CI, 0.16 to 0.84, p=0.02), with no observable difference in the occurrence of MACE or vascular complications. In post-hoc analyses of the large, multicentre, HORIZONS-AMI randomised controlled trial, a daily dose of aspirin >200 vs ≤200 mg on discharge was an independent predictor of major bleeding (HR, 2.80; 95% CI, 1.31 to 5.99, p = 0.008), but not of adverse ischemic events, and, female sex was an independent risk factor for major bleeding out to 3 years (HR, 1.81, 95% CI, 1.41 – 2.33, P