Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. James Kong

Committee Member

Dr. Maureen Corl

Committee Member

Dr. Melissa Czarapata

Abstract

OBJECTIVE: It is well documented that the most common problems associated with diagnostic and interventional angiography are major bleeding and vascular complications. While previous research and the American College of Cardiology (ACC) recommend the use of bleeding risk stratification tools, there is little evidence related to the use of bleeding avoidance strategies in the high-risk for bleeding population. This study aims to determine if individualizing access site and anticoagulation strategies based on bleeding risk stratification would positively impact NCDR Risk-Adjusted Bleeding Rates.

METHODS: This was a single-center pilot study utilizing retrospective chart reviews with pre/post design. Data was collected on all percutaneous coronary interventions (PCI) from 3 interventionalists excluding ST elevation myocardial infarction (STEMI) and staged chronic total occlusion (CTO) procedures. Variables analyzed in the study included age, gender, body mass index (BMI), bleeding risk score, access site, anticoagulation strategy, P2Y12 inhibitor used, use of GPIIbIIIa inhibitors, use of vascular closure devices, ultrasound use, bleeding events, blood transfusions and the previous diagnosis of heart failure, end-stage renal disease, and diabetes mellitus. The study compared baseline data (3 months prior to implementation) to post implementation data (3 months after implementation).

RESULTS: High bleeding risk patients comprised 14% and 18% of the baseline and post implementation groups respectively; after exclusion criteria was considered, only 9.4% and 10.7% of the PCI subjects were utilized for analysis. Sample sizes were too small to show statistically significant differences between the baseline and post implementation groups.

CONCLUSION: Further research is necessary to directly correlate the benefits of individualizing patient care based on bleeding risk stratification.

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