title: Beneficial effects of a point-of-care bleeding risk calculator on anticoagulant selection in the coronary catheterization laboratory.
abstract: OBJECTIVE
  To estimate periprocedural bleeding risk before elective percutaneous coronary intervention (PCI) by using a point-of-care bleeding risk calculator and to document changes in anticoagulant use and bleeding complications after implementation of use of this calculator.
  
  
  METHODS
  Prospective observational pilot study with a historical control cohort.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  The pilot cohort consisted of 100 patients undergoing ad hoc PCI during elective cardiac catheterization procedures between January and May 2013, whose bleeding risk and accompanying PCI anticoagulant recommendations were determined by the use of a pre-PCI point-of-care bleeding risk calculator. The historical control cohort consisted of all patients who underwent elective PCI at the same facility between April 1, 2011, and March 31, 2012, before implementation of use of the bleeding risk calculator.
  
  
  RESULTS
  The pre-PCI bleeding risk calculator distinguished patients in the pilot cohort as high risk (score 12 or higher) or low risk (lower than 12) for bleeding after a PCI procedure. The primary outcome was bivalirudin use in the pilot cohort compared with its use in the historical control cohort. Implementation of the bleeding risk calculator significantly decreased bivalirudin use compared with bivalirudin use in the historical control cohort (87% in the control cohort vs 60% in the pilot cohort, p<0.01). Bivalirudin use remained high in patients at high bleeding risk (82.2% in the pilot cohort vs 87.4% in the control cohort, p=0.3) and its use was decreased in patients at low bleeding risk (41.8% in the pilot cohort vs 87.1% in the control cohort, p<0.01). The incidence of bleeding complications in the pilot cohort was comparable with that in the control cohort (1% vs. 0.4%, p=0.37), although this pilot study was underpowered to potentially detect a significant change in the incidence of bleeding complications.
  
  
  CONCLUSIONS
  A simple bleeding risk calculator can substantially reduce overall bivalirudin use by specifically decreasing its use among patients at low bleeding risk while maintaining its use among patients at high bleeding risk. The incidence of bleeding complications remained unchanged despite decreasing bivalirudin use among patients undergoing elective coronary catheterization who were at low risk for bleeding.
authors.affiliation: Department of Pharmacy Services, Meriter Unity-Point Health, Madison, Wisconsin.
authors.forename: Jocelyn J
authors.initials: JJ
authors.lastname: Kerl
authors.forename: Frank C
authors.initials: FC
authors.lastname: Spexarth
authors.forename: Rachel
authors.initials: R
authors.lastname: Pedersen
authors.forename: Mia
authors.initials: M
authors.lastname: Stone
authors.forename: Suhail Q
authors.initials: SQ
authors.lastname: Allaqaband
authors.forename: James L
authors.initials: JL
authors.lastname: Schulgit
authors.forename: Tanvir K
authors.initials: TK
authors.lastname: Bajwa
authors.forename: Anjan N
authors.initials: AN
authors.lastname: Gupta
authors.forename: Anthony C
authors.initials: AC
authors.lastname: DeFranco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005919:Glomerular Filtration Rate; D017048:Health Care Costs; D006470:Hemorrhage / Q000191:economics / Q000517:prevention & control*; D006629:Hirudins; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: PCI; bivalirudin; bleeding risk calculator; percutaneous coronary intervention; unfractionated heparin