title: Factors related to a clinically silent peri-procedural drop in hemoglobin with coronary and peripheral vascular interventions.
abstract: Clinically evident and subclinical peri-procedural bleeding following interventional therapies are associated with adverse cardiovascular outcomes. The risk factors for clinically evident bleeding have been well described. Despite the well-documented association of adverse outcomes for patients with a subclinical peri-procedural hemoglobin drop, the clinical predictors have not yet been defined. We identified 1176 consecutive patients with a subclinical drop in hemoglobin (fall of ≥ 1 g/dl in patients without clinical bleeding) following percutaneous coronary interventions (PCI) and peripheral vascular interventions (PVI). Multivariate logistic regression analysis was performed. A subclinical peri-procedural hemoglobin drop ≥ 1 g/dl was identified in 41% (400/972) of PCI and in 49% (213/435) of PVI. More than one access site predicted a higher risk of a subclinical drop in hemoglobin in both groups. A body mass index ≥ 30 predicted a lower risk of a subclinical drop in hemoglobin in both groups. For PCI, creatinine clearance < 60 ml/min was associated with a higher risk of a subclinical drop in hemoglobin. In conclusion, clinically silent peri-procedural hemoglobin fall ≥ 1 g/dl is common in patients undergoing both coronary and peripheral percutaneous intervention. Predictors identified in our study will need prospective validation.
authors: Department of Cardiology, Ochsner Heart and Vascular Institute, John Ochsner Clinic Foundation, New Orleans, LA, USA. zjaffery@ochsner.org
authors: Zehra
authors: Z
authors: Jaffery
authors: Christopher J
authors: CJ
authors: White
authors: Tyrone J
authors: TJ
authors: Collins
authors: Mark A
authors: MA
authors: Grise
authors: J Stephen
authors: JS
authors: Jenkins
authors: Paul W
authors: PW
authors: McMullan
authors: Rajan A
authors: RA
authors: Patel
authors: John P
authors: JP
authors: Reilly
authors: Stanley N
authors: SN
authors: Thornton
authors: Stephen R
authors: SR
authors: Ramee
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015992:Body Mass Index; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000097:blood / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins; D003404:Creatinine