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We did a pre/post-implementation study at nine large US percutaneous coronary intervention centers and evaluated changes in use of bleeding avoidance strategies and bleeding outcomes, while correcting for contemporary trends among matched NCDR CathPCI hospitals that did not have access to the ePRISM tool.
Hospital level and physician level variability in use of bleeding avoidance strategies was examined.
Marked variability in use of bleeding avoidance strategies was observed across sites and physicians, both before and after implementation.
We were unable to attribute the reduction in bleeding solely to the observed changes in use of bleeding avoidance strategies.
The CathPCI Registry study 36 evaluated trends in use of bleeding avoidance strategies (direct thrombin inhibitors, vascular closure devices, and radial access) and risk-adjusted bleeding over time.
We used hierarchical logistic regression models to assess the effect of exposure to ePRISM on physicians' change in use of bleeding avoidance strategies and the incidence of post-procedural bleeding, corrected for concurrent trends among control hospitals.
Similar(51)
Among the nine study sites, we derived variability in physicians' use of bleeding avoidance strategies as a function of bleeding risk both before and after implementation of ePRISM from the estimated random effects from the model incorporating bleeding risk as a continuous variable.
In multivariable analysis, use of bleeding avoidance strategies was associated with a lower risk of bleeding.
In the post-implementation period, use of bleeding avoidance strategies ranged from 31%to98%8%, bivalirudin use ranged from 1% to 96%, vascular closure device use ranged from 3%to70%0%, and radial access ranged from 1% to 51% across hospitals.
Study outcomes included use of bleeding avoidance strategies and in-hospital, post-procedural bleeding rates.
We hypothesized that prospective stratification of bleeding risk could improve the use of bleeding avoidance strategies in higher risk patients and reduce bleeding in patients undergoing percutaneous coronary intervention.
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