Background: The risk of bleeding is accentuated in patients with atrial fibrillation (AF) who undergo percutaneous coronary interventions (PCI) due to combined anti-platelet/anticoagulant regimens. Periprocedural PCI bleeding risk is important to consider when choosing an access-site for cardiac catheterization.
Aim: To characterize the occurrence and type of post-PCI clinically significant bleeds (CSB) within 30 days of cardiac catheterization in patients with AF.
Methods: In the PIONEER AF-PCI trial, 2124 patients with AF underwent PCI with stent placement. Access sites for cardiac catheterization included the brachial, femoral, or radial artery. CSB was a composite of TIMI major and TIMI minor bleeds, and bleeding requiring medical attention (BRMA). The distribution of CSB that occurred within 30 days of index cardiac catheterization was reported.
Results: Overall, 773 (36.4%), and 1342 (63.2%) patients underwent PCI via the femoral and radial artery, respectively. Within 30 days post-PCI, 111 CSB occurred. Of these, only 5 (4.5%) CSB were access-site bleeds and 106 (95.5%) were non-access site bleeds. TIMI major non-access site bleeds accounted for 9.0% of all CSB, 6.3% were TIMI minor non-access site bleeds and 76.6% were non-access site BRMA. The most frequent types of TIMI major bleeds were gastrointestinal (GI, n=5) and intracranial hemorrhage, (n=4), which collectively comprised 8.1% of all CSB within 30 days. GI bleeds represented 22.5% (n=25) of all post-PCI CSB within 30 days.
Conclusions: Among patients with AF undergoing PCI, the most common early CSB within 30 days were GI bleeds while access site bleeds were relatively rare. In contemporary interventional practice, the occurrence of access site bleeds is rare even in high risk groups. Therefore, emphasis, among those PCI patients with AF, needs to now focus on how to reduce non-access site bleeds.