title: Number of severe bleeding complications according to classification used: Is unified classification of bleeding complications really necessary?
abstract: BACKGROUND
  To compare the number of severe periprocedural bleeding complications from the total number of bleeding complications associated with diagnostic selective coronary angiography or percutaneous coronary intervention (PCI) when using different classifications (TIMI, GUSTO, PLATO, BARC) and to relate these classifications to real hemodynamic status of evaluated patients.
  
  
  METHODS
  We analyzed data from 106 patients who underwent invasive procedure for ischemic heart disease (selective coronary angiography/PCI) and suffered from any type of bleeding complication.
  
  
  RESULTS
  The number of bleeding according to impacts on hemodynamic status and consequent treatment shows that 54.7% of all bleedings did not need any specific therapy. Bleeding leading to death, hemorrhagic shock, hemodynamic instability, administration of blood transfusion, surgical procedure and local treatment occurred in 6.6%, 1.9%, 5.7%, 14.2%, 2.8%, and 14.2%, respectively. The results comparing bleeding classifications demonstrate that the rate of severe bleeding complications may increase up to 4 times when different classifications are used on the same group of patients (TIMI 9.4%, GUSTO 15.1%, PLATO 39.2% and BARC 35.9%). The power of association between severe bleeding determined by these classifications and real hemodynamic compromise using Kendall's tau-c correlation is -0.4106 (95% CI -0.599 to -0.222), -0.5355 (95% CI -0.718 to -0.353), -0.5513 (95% CI -0.729 to -0.374) and -0.7552 (95% CI -0.897 to -0.612) for TIMI, GUSTO, PLATO and BARC, respectively.
  
  
  CONCLUSIONS
  The data show significant dependence of percentage of severe periprocedural bleeding complications on selected classification. The strongest association between severe bleeding and real hemodynamic status was found for BARC classification as this classification seems to be promising for future general use.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Sionova
authors.forename: Peter
authors.initials: P
authors.lastname: Blasko
authors.forename: Stepan
authors.initials: S
authors.lastname: Jirous
authors.forename: David
authors.initials: D
authors.lastname: Vindis
authors.forename: Richard
authors.initials: R
authors.lastname: Rokyta
authors.forename: Lenka
authors.initials: L
authors.lastname: Posch
authors.affiliation: Charles Univ.. motovska.zuzana@gmail.com.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Motovska
mesh_terms: D000368:Aged; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: bleeding complications; classification of bleeding; ischemic heart disease