Author + information
- Received January 21, 2011
- Accepted February 10, 2011
- Published online June 28, 2011.
- Harold L. Dauerman, MD⁎,⁎ (, )
- Sunil V. Rao, MD†,
- Frederic S. Resnic, MD§ and
- Robert J. Applegate, MD‡
- ↵⁎Reprint request and correspondence:
Dr. Harold L. Dauerman, Division of Cardiology, McClure 1, University of Vermont College of Medicine, 111 Colchester Avenue, Burlington, Vermont 05401
Bleeding complications after coronary intervention are associated with prolonged hospitalization, increased hospital costs, patient dissatisfaction, morbidity, and 1-year mortality. Bleeding avoidance strategies is a term incorporating multiple modalities that aim to reduce bleeding and vascular complications after cardiovascular catheterization. Recent improvements in the rates of bleeding complications after invasive cardiovascular procedures suggest that the clinical community has successfully embraced specific strategies and improved patient care in this area. There remains controversy regarding the efficacy, safety, and/or practicality of 3 key bleeding avoidance strategies for cardiac catheterization and coronary intervention: procedural (radial artery approach, safezone arteriotomy), pharmacological (multiple agents), and technological (vascular closure devices) approaches to improved access. In this paper, we address areas of consensus with respect to selected modalities in order to define the role of each strategy in current practice. Furthermore, we focus on areas of controversy for selected modalities in order to define key areas warranting cautious clinical approaches and the need for future randomized clinical trials in this area.
FDA research contract HHSF Contract 223200830058C (related to medical device safety) and NIH research grant R01 LM008142-04 (related to medical device safety surveillance). Dr. Dauerman has received research support and/or consulted on behalf of The Medicines Company, Abbott Vascular, Medtronic, and St. Jude. Dr. Rao has the is on the Speakers' Bureau of and has received honoraria from sanofi-aventis, Bristol-Myers Squibb, and The Medicines Company; is a consultant for sanofi-aventis, Bristol-Myers Squibb, Daiichi Sankyo Lilly, AstraZeneca, The Medicine Company, and Terumo USA; and has received research funding from Portola Pharmaceuticals Inc., Novartis, Ikaria, and Cordis Corporation. Dr. Resnic is a consultant to St. Jude Medical, Medtronic, and Agfa corp.; and has received a research grant from The Medicines Company. Dr. Applegate is on the advisory boards of Abbott Vascular; has received research grants from Abbott Vascular, St. Jude, and Terumo; and has received honorarium from Abbott Vascular and St. Jude Medical.
- Received January 21, 2011.
- Accepted February 10, 2011.
- American College of Cardiology Foundation
- Temporal Trends in Bleeding and Vascular Complications
- Procedural Reduction in Bleeding Complications and the Radial Artery Approach
- Pharmacological Reduction in Bleeding Complications
- Mechanical Reduction in Bleeding Complications: VCDs
- Systematic Reduction in Bleeding Complications and Cost Effectiveness
- Consensus, Controversy, and Practice Recommendations