title: Association Of Bleeding Avoidance Strategies with age-related bleeding and In-hospital mortality in patients undergoing percutaneous coronary Interventions.
abstract: BACKGROUND
  The association of bleeding avoidance strategy (BAS) (consisting of a combination of radial access, bivalirudin [rather than heparin +/- glycoprotein GPIIb/IIIa antagonists], and/or vascular closure devices after femoral access) with bleeding and in-hospital outcomes has not been evaluated among elderly patients undergoing percutaneous coronary interventions (PCI).
  
  
  METHODS
  We studied BAS use, bleeding and in-hospital mortality among 121,635 patients categorized by age (<50, 50-59, 60-69, 70-79, and ≥80years) undergoing PCI from the BMC2 registry (1/2010-12/2013).
  
  
  RESULTS
  The use of BAS decreased marginally with age and despite improved utilization over time, remained lower among the elderly. BAS was used in a much lower risk cohort among all age groups. Nonetheless, compared with no BAS, the use of this strategy was associated with lower bleeding (adjusted OR 0.984, 95% CI 0.980-0.985) and in-hospital mortality (adjusted OR 0.996, 95% CI 0.994-0.997) among all age-groups. Similar relative reduction in the risk of bleeding was observed among all age groups with BAS use with lowest risk (thus greatest absolute risk reduction given their highest risk for bleeding) for the oldest cohort.
  
  
  CONCLUSIONS
  BAS use decreased with age among patients undergoing PCI despite its association with lower in-hospital mortality. Although overall utilization improved over time, it still remained lower in the elderly cohort, a group likely to benefit most from it. These data identified an opportunity to design strategies to improve BAS use particularly among high-risk elderly patients undergoing PCI so as to decrease bleeding and reduce related adverse events and costs.
authors.affiliation: St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Sherezade
authors.initials: S
authors.lastname: Khambatta
authors.affiliation: St. John Hospital and Medical Center, Detroit, Michigan. Electronic address: Hussein.othman@stjohn.org.
authors.forename: Hussein
authors.initials: H
authors.lastname: Othman
authors.affiliation: University of Michigan, Ann, Arbor, Michigan.
authors.forename: Milan
authors.initials: M
authors.lastname: Seth
authors.affiliation: St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lalonde
authors.affiliation: St. John Hospital and Medical Center, Detroit, Michigan.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Rosman
authors.affiliation: University of Michigan, Ann, Arbor, Michigan.
authors.forename: Hitinder S
authors.initials: HS
authors.lastname: Gurm
authors.affiliation: Duke Clinical Research Institute and Duke University Medical Center, Durham, North Carolina.
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D054598:Blue Cross Blue Shield Insurance Plans; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics / Q000628:therapy*; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000295:instrumentation; D006629:Hirudins / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010446:Peptide Fragments / Q000009:adverse effects / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011677:Punctures; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: Bleeding; Bleeding avoidance strategies; Elderly; PCI