Bleeding after percutaneous coronary intervention (PCI) is associated with increased morbidity, mortality, and cost. Transradial access (TRA), bivalirudin (BIV), and vascular closure devices (VCD) are strategies to reduce bleeding. We compared the impact of these bleeding avoidance strategies (BAS) in patients with varying levels of bleeding risk.

We performed a retrospective cohort analysis of 74,953 PCIs within a multistate healthcare system from 2009Q3-2017Q4. We assessed bleeding risk per the NCDR PCI bleeding model. PCIs were stratified into six bleeding risk groups—1st, 2nd, 3rd quartile, 75th-90th, 90th-97.5th and top 2.5th percentile—to balance risk between BAS. Regression modeling was used to assess the impact of BAS on bleeding.

Raw bleeding rates were 4.4% overall and 9.6%, 5.8%, 5.4%, 3.2%, 2.0%, and 1.7% in patients receiving no BAS, BIV, VCD, VCD + BIV, TRA, and TRA + BIV, respectively. Non-access site bleeds accounted for greater than 90% of events. In regression models, patients who received TRA or VCD + BIV had significantly lower odds of bleeding compared to no BAS across all risk groups (Table). TRA had significantly lower odds of bleeding compared to BIV or VCD across all risk groups except the top 2.5th percentile. Addition of BIV to TRA did not significantly impact the odds of bleeding.

BAS have varying effects on PCI-related bleeding, with TRA providing the greatest benefit. Addition of BIV to TRA did not further reduce bleeding.