Abstract 11295: Beneficial Effect of a Point-of-Care Bleeding Risk Calculator on Anticoagulant Selection and Resource Utilization: A Pilot Study
Introduction: ACC/AHA guidelines do not recommend a preferred anticoagulant for percutaneous coronary intervention (PCI). Data suggest that in patients at high bleeding risk, bivalirudin decreases bleeding compared to unfractionated heparin. National registries demonstrate a “risk-treatment paradox,” i.e. patients at high bleeding risk are less likely to receive bivalirudin than patients at low bleeding risk.
Hypothesis: Objectives of this pilot study were to estimate periprocedural bleeding risk prior to PCI using a validated risk-scoring tool (NCDR risk model) and document subsequent changes in anticoagulant use and bleeding.
Methods: In a baseline population (n=2,331) that underwent a total of 814 elective PCI procedures from April 2011 to March 2012, we retrospectively established a pre-PCI bleeding risk calculator that distinguished patients as high (score ≥12) or low bleeding risk (<12).
Results: During the pilot period (1/14/2013 to 5/3/2013), four cardiologists completed 101 elective PCIs. There was a significant decrease in overall bivalirudin use compared to baseline (p<0.0001, Fig. 1). Bivalirudin use increased in patients at high bleeding risk and decreased in patients at low bleeding risk (Fig. 2). Though underpowered, the incidence of bleeding complications in the pilot (1.0%) was comparable to baseline (0.4%), p=0.37.
Conclusions: A simple bleeding risk calculator: A) substantially reduces overall bivalirudin use and cost per case, and B) reverses the risk-treatment paradox by shifting use of bivalirudin from patients at low bleeding risk to patients at high bleeding risk. Bleeding events were not significantly different from baseline.
- © 2013 by American Heart Association, Inc.