title: Evaluation of procedure-related bleeding risk in patients receiving bivalirudin during percutaneous coronary intervention.
abstract: BACKGROUND
  Bivalirudin has historically been considered an attractive anticoagulant during percutaneous coronary intervention (PCI) because of reduced bleeding complications reported by early trials. Bivalirudin use during PCIs has been a subject of controversy because of conflicting data and recent findings.
  
  
  OBJECTIVE
  To evaluate the clinical characteristics of patients receiving bivalirudin to determine if an opportunity to improve use exists based on risk of procedure-related bleeding.
  
  
  METHODS
  This was a single-center, retrospective, observational study (n = 100) of all adult patients who received bivalirudin during cardiac catheterization at St John Hospital and Medical Center from June to August 2013. The risk of bleeding complications associated with PCI was estimated using a clinical risk algorithm developed from the National Cardiovascular Data Registry (NCDR).
  
  
  RESULTS
  Treatment with bivalirudin was safe and effective. Of the 100 patients who received bivalirudin, only 34% were identified as having a high risk of procedure-related bleeding according to the NCDR clinical risk algorithm. There was no incidence of stent thrombosis noted and only 1 case of provisional glycoprotein IIb/IIIa inhibitor use. No episodes of Thrombolysis in Myocardial Infarction (TIMI) major bleeding were noted in the study population; however, 1 patient met TIMI minor bleeding criteria. Limitations of this study include small sample size and retrospective nature of the study.
  
  
  CONCLUSIONS
  Opportunities to establish a more cost-effective use of bivalirudin may exist through implementation of protocols incorporating the NCDR risk assessment model.
authors: St John Hospital and Medical Center, Detroit, MI, USA.
authors: Vivian S
authors: VS
authors: Baek
authors: St John Hospital and Medical Center, Detroit, MI, USA.
authors: Jeff
authors: J
authors: Hurren
authors: St John Hospital and Medical Center, Detroit, MI, USA Stephanie.Edwin@stjohn.org.
authors: Stephanie B
authors: SB
authors: Edwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D010446:Peptide Fragments / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: bivalirudin; bleeding; percutaneous coronary intervention