TY - JOUR
T1 - Bleeding, Blood Transfusion, and Increased Mortality After Percutaneous Coronary Intervention. Implications for Contemporary Practice
AU - Doyle, Brendan J.
AU - Rihal, Charanjit S.
AU - Gastineau, Dennis A.
AU - Holmes, David R.
PY - 2009/6/2
Y1 - 2009/6/2
N2 - Advances in percutaneous coronary intervention (PCI) during the past decade have led to more widespread use of these procedures in older and sicker patients. Refinement of periprocedural antithrombotic therapy has played a particularly important role in reducing ischemic complications to very low levels in routine practice. Although the use of more powerful antiplatelet agents has been associated with increased risk of bleeding (especially among the elderly and patients with serious comorbidities), such complications have traditionally been viewed as benign in nature. Recent studies, however, have identified major bleeding after PCI as an important predictor of increased mortality. Whether this relationship between bleeding and risk of death is cause-and-effect, or merely an association based on shared risk factors, remains unclear. In this review, we examine the basis for a possible causal link between post-PCI bleeding and subsequent mortality. Possible mechanisms underpinning such a link are discussed, including a potential adverse role for blood transfusion in this setting. A framework for further clinical evaluation of this issue is presented.
AB - Advances in percutaneous coronary intervention (PCI) during the past decade have led to more widespread use of these procedures in older and sicker patients. Refinement of periprocedural antithrombotic therapy has played a particularly important role in reducing ischemic complications to very low levels in routine practice. Although the use of more powerful antiplatelet agents has been associated with increased risk of bleeding (especially among the elderly and patients with serious comorbidities), such complications have traditionally been viewed as benign in nature. Recent studies, however, have identified major bleeding after PCI as an important predictor of increased mortality. Whether this relationship between bleeding and risk of death is cause-and-effect, or merely an association based on shared risk factors, remains unclear. In this review, we examine the basis for a possible causal link between post-PCI bleeding and subsequent mortality. Possible mechanisms underpinning such a link are discussed, including a potential adverse role for blood transfusion in this setting. A framework for further clinical evaluation of this issue is presented.
KW - bleeding
KW - blood transfusion
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=65649119646&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=65649119646&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2008.12.073
DO - 10.1016/j.jacc.2008.12.073
M3 - Review article
C2 - 19477350
AN - SCOPUS:65649119646
SN - 0735-1097
VL - 53
SP - 2019
EP - 2027
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 22
ER -