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Bleeding events are the most common complication of percutaneous coronary interventions (PCI). A severe bleeding event can outweigh the benefits of a PCI, contributing to increased morbidity, mortality and costs. We sought to develop an electronic medical record (EMR) based system to assess bleeding risk and decrease bleeding rates in PCI patients.
We analyzed all PCIs at our institution over a 1-year period (1,548 PCIs and 88 bleeding events for a 5.7% event rate). Bleed events were categorized using NCDR criteria and could be counted in multiple categories. The most frequent events were hemoglobin drop >3 g/dL and transfusions (50 for each; 3.2%). Utilizing the validated NCDR risk score, we developed an EMR based bleeding risk calculator (BRC) to determine bleeding risk prior to PCI. The tool was integrated into the EMR and is completed at the time of consent. The BRC was launched in February 2016.
Comparisons were made with data from 1/2015 to 7/2015 (6months) and 2/2016 to 5/2016 (4 months) following the BRC launch. There were 787 PCIs and 46 bleeds in the pre-launch period and 551 PCIs and 18 bleeds in the post-launch period (bleeding rate 5.8% vs 3.2%; p=0.029). Completion rate of the bleeding risk score was 45% during the measurement period. Bleeding rate in the BRC completion group was 1.3% vs. 4.1% in the group without pre-procedure BRC use (p=0.056). Blood transfusions remained high, with 8 of the 18 bleeds in the post BRC period receiving a transfusion, 5 of which had hemoglobin values of >7g/dL.
Implementation of an EMR based BRC can significantly reduce bleeding events in post-PCI patients. Reduced bleeding events occurred in patients who had a bleeding risk score calculated prior to PCI. Despite its demonstrated efficacy, full adoption remains an obstacle. Transfusions following PCI also remain elevated, indicating that further education around appropriate transfusion criteria is also required.
CORONARY: PCI Outcomes