title: Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National Cardiovascular Data Registry.
abstract: OBJECTIVE
  This study sought to compared the use and effectiveness of bleeding avoidance strategies (BAS) by sex.
  
  
  BACKGROUND
  Women have higher rates of bleeding following percutaneous coronary intervention (PCI).
  
  
  METHODS
  Among 570,777 men (67.5%) and women (32.5%) who underwent PCI in the National Cardiovascular Data Registry's CathPCI Registry between July 1, 2009 and March 31, 2011, in-hospital bleeding rates and the use of BAS (vascular closure devices, bivalirudin, radial approach, and their combinations) were assessed. The relative risk of bleeding for each BAS compared with no BAS was determined in women and men using multivariable logistic regressions adjusted for clinical characteristics and the propensity for receiving BAS. Finally, the absolute risk differences in bleeding associated with BAS were compared.
  
  
  RESULTS
  Overall, the use of any BAS differed slightly between women and men (75.4% vs. 75.7%, p = 0.01). When BAS was not used, women had significantly higher rates of bleeding than men (12.5% vs. 6.2%, p < 0.01). Both sexes had similar adjusted risk reductions of bleeding when any BAS was used (women, odds ratio: 0.60, 95% confidence interval [CI]: 0.57 to 0.63; men, odds ratio: 0.62, 95% CI: 0.59 to 0.65). Women and men had lower absolute bleeding risks with BAS; however, these absolute risk differences were greater in women (6.3% vs. 3.2%, p < 0.01).
  
  
  CONCLUSIONS
  Women continue to have almost twice the rate of bleeding following PCI. The use of any BAS was associated with a similarly lower risk of bleeding for men and women; however, the absolute risk differences were substantially higher in women. These data underscore the importance of applying effective strategies to limit post-PCI bleeding, especially in women.
authors.affiliation: Department of Medicine and the Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA. stacie.daugherty@ucdenver.edu
authors.forename: Stacie L
authors.initials: SL
authors.lastname: Daugherty
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Thompson
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006488:Hemostasis, Surgical / Q000706:statistics & numerical data*; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy*; D018579:Patient Selection; D010446:Peptide Fragments / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin