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Design Prospective cohort study comparing the use of bleeding avoidance strategies and bleeding rates before and after implementation of prospective risk stratification for peri-procedural bleeding.
Objective To examine whether prospective bleeding risk estimates for patients undergoing percutaneous coronary intervention could improve the use of bleeding avoidance strategies and reduce bleeding.
11 The use of bleeding avoidance strategies at the time of percutaneous coronary intervention is a prototypical example of the risk-treatment paradox.
12 13141516171819 18 19 It is also modifiable through the use of bleeding avoidance strategies, such as bivalirudin, radial percutaneous coronary intervention, and, potentially, vascular closure devices.
The use of bleeding risk scores [ 43] and more real-life data on the benefit-to-risk profile of NOACs in patients at increased risk of bleeding are needed.
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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22 Because the physicians' education components of the intervention encouraged use of bleeding avoidance strategies in patients at moderate or high risk for bleeding, the categorical analyses of bleeding outcomes and changes in bleeding avoidance strategy use are between patients with low and moderate/high risk (<1% v ≥1%) for bleeding.
We were unable to attribute the reduction in bleeding solely to the observed changes in use of bleeding avoidance strategies.
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.
Large surface areas in artificial lungs demand the use of anticoagulation, and bleeding complications have been high in previous ECCO2R trails [12].
PCC contains coagulation factors II, VII, IX, and X, and proteins C, S, and Z in concentrated form [6]. European and Australian practice protocols recommend the use of PCC in bleeding emergencies [6].
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