CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

December 9th, 2009

Bleeding With PCI: We’re Making The Problem Worse

In a recent editorial regarding the management of ACS patients, we emphasized the importance of early risk stratification to identify patients who would most benefit (or not benefit) from intensive antithrombotic therapy or an invasive cardiac procedure.  

However, a recently published study reported that 22% of dialysis patients  undergoing PCI received an antithrombotic agent (enoxaparin or eptifibatide) that was contraindicated in individuals with renal disease.  Not surprisingly, the use of these agents was associated with an increased risk of major bleeding and death.  

As inverventionalists, do we know how to assess (and minimize) bleeding risks in our PCI patients?  

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One Response to “Bleeding With PCI: We’re Making The Problem Worse”

  1. Harlan M. Krumholz, MD, SM says:
    December 31, 2009 at 9:12 am

    The answer in the case of Tom Tsai’s paper is clear — we should not be using contraindicated drugs that increase risk. But what are you doing now to risk stratify your patients and how are your therapeutic choices influenced by that risk? Practically speaking — what should be done to lower bleeding risk — and what bleeding risk score should we be using regularly to guide decisions?