Bleeding Associated with Angiography and Percutaneous Coronary Intervention

  • Serdar Farhan
  • Usman Baber
  • Roxana MehranEmail author


A mandatory and necessary component of any coronary intervention is the use of antiplatelet and anticoagulant therapy, which lowers thrombotic risk yet simultaneously exposes patients to potential bleeding harm. Over the last several decades numerous antithrombotic drugs have been investigated and received approval based upon lowering thrombotic events, albeit at an excess cost of bleeding. Currently bleeding is the most common early complication associated with percutaneous coronary intervention. Beside the higher healthcare costs, bleeding complications are associated with a higher risk of mortality [Aggarwal B, Ellis SG, Lincoff AM, Kapadia SR, Cacchione J, Raymond RE, Cho L, Bajzer C, Nair R, Franco I, Simpfendorfer C, Tuzcu EM, Whitlow PL, Shishehbor MH, J Am Coll Cardiol 62:409–415, 2013]. In order to improve quality of care and outcomes, several studies have been conducted to better stratify bleeding risk, implement uniform bleeding scales, and develop preventive measures. In this chapter we provide a review on definition, risk assessment, prevention, and treatment of bleeding complications associated with interventional procedures.


Coronary artery disease Percutaneous coronary intervention Bleeding complication Anticoagulation Antiplatelet drugs Atrial fibrillation Bleeding Academic Research Consortium 


  1. 1.
    Aggarwal B, Ellis SG, Lincoff AM, Kapadia SR, Cacchione J, Raymond RE, Cho L, Bajzer C, Nair R, Franco I, Simpfendorfer C, Tuzcu EM, Whitlow PL, Shishehbor MH. Cause of death within 30 days of percutaneous coronary intervention in an era of mandatory outcome reporting. J Am Coll Cardiol. 2013;62:409–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Ludbrook P, et al. Thrombolysis in myocardial infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987;76:142–54.CrossRefPubMedGoogle Scholar
  3. 3.
    The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993;329:673–82.CrossRefGoogle Scholar
  4. 4.
    Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Investigators PLATO, Freij A, Thorsen M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045–57.CrossRefPubMedGoogle Scholar
  5. 5.
    Stone GW, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Dangas G, Wong SC, Kirtane AJ, Parise H, Mehran R, HORIZONS-AMI Trial Investigators. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358:2218–30.CrossRefPubMedGoogle Scholar
  6. 6.
    Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.CrossRefPubMedGoogle Scholar
  7. 7.
    Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, Bode C, Chiariello M, King SB 3rd, Harrington RA, Desmet WJ, Macaya C, Steinhubl SR, STEEPLE Investigators. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med. 2006;355:1006–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Rao SV, McCoy LA, Spertus JA, Krone RJ, Singh M, Fitzgerald S, Peterson ED. An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry. JACC Cardiovasc interv. 2013;6:897–904.CrossRefPubMedGoogle Scholar
  9. 9.
    Lopes RD, Subherwal S, Holmes DN, Thomas L, Wang TY, Rao SV, Magnus Ohman E, Roe MT, Peterson ED, Alexander KP. The association of in-hospital major bleeding with short-, intermediate-, and long-term mortality among older patients with non-ST-segment elevation myocardial infarction. Eur Heart J. 2012;33:2044–53.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Suh JW, Mehran R, Claessen BE, Xu K, Baber U, Dangas G, Parise H, Lansky AJ, Witzenbichler B, Grines CL, Guagliumi G, Kornowski R, Wohrle J, Dudek D, Weisz G, Stone GW. Impact of in-hospital major bleeding on late clinical outcomes after primary percutaneous coronary intervention in acute myocardial infarction the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial. J Am Coll Cardiol. 2011;58:1750–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Ndrepepa G, Berger PB, Mehilli J, Seyfarth M, Neumann FJ, Schomig A, Kastrati A. Periprocedural bleeding and 1-year outcome after percutaneous coronary interventions: appropriateness of including bleeding as a component of a quadruple end point. J Am Coll Cardiol. 2008;51:690–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Sharma SK, Baber U. The shifting pendulum for DAPT after PCI: balancing long-term risks for bleeding and thrombosis. J Am Coll Cardiol. 2015;66:1046–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Stasko J, Drouet L, Soria C, Mazoyer E, Caen J, Kubisz P. Erythropoietin and granulocyte colony-stimulating factor increase plasminogen activator inhibitor-1 release in HUVEC culture. Thromb Res. 2002;105:161–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Mehran R, Baber U, Steg PG, Ariti C, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Berger PB, Iakovou I, Dangas G, Waksman R, Antoniucci D, Sartori S, Krucoff MW, Hermiller JB, Shawl F, Gibson CM, Chieffo A, Alu M, Moliterno DJ, Colombo A, Pocock S. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet. 2013;382:1714–22.CrossRefPubMedGoogle Scholar
  15. 15.
    Sherwood MW, Wang Y, Curtis JP, Peterson ED, Rao SV. Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention. JAMA. 2014;311:836–43.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Cooper HA, Rao SV, Greenberg MD, Rumsey MP, McKenzie M, Alcorn KW, Panza JA. Conservative versus liberal red cell transfusion in acute myocardial infarction (the CRIT Randomized Pilot Study). Am J Cardiol. 2011;108:1108–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Carson JL, Brooks MM, Abbott JD, Chaitman B, Kelsey SF, Triulzi DJ, Srinivas V, Menegus MA, Marroquin OC, Rao SV, Noveck H, Passano E, Hardison RM, Smitherman T, Vagaonescu T, Wimmer NJ, Williams DO. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J. 2013;165:964–71. e961CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Daugherty SL, Thompson LE, Kim S, Rao SV, Subherwal S, Tsai TT, Messenger JC, Masoudi FA. Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013;61:2070–8.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ndrepepa G, Kastrati A. Bleeding complications in patients undergoing percutaneous coronary interventions: current status and perspective. Coron Artery Dis. 2014;25:247–57.CrossRefPubMedGoogle Scholar
  20. 20.
    Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, Wang TY, Gibler WB, Ohman EM, Roe MT, Pollack CV Jr, Peterson ED, Alexander KP. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (can rapid risk stratification of unstable angina patients suppress ADverse outcomes with early implementation of the ACC/AHA guidelines) bleeding score. Circulation. 2009;119:1873–82.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Mehran R, Pocock S, Nikolsky E, Dangas GD, Clayton T, Claessen BE, Caixeta A, Feit F, Manoukian SV, White H, Bertrand M, Ohman EM, Parise H, Lansky AJ, Lincoff AM, Stone GW. Impact of bleeding on mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials. JACC Cardiovasc Interv. 2011;4:654–64.CrossRefPubMedGoogle Scholar
  22. 22.
    Marso SP, Amin AP, House JA, Kennedy KF, Spertus JA, Rao SV, Cohen DJ, Messenger JC, Rumsfeld JS, National Cardiovascular Data R. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA. 2010;303:2156–64.CrossRefPubMedGoogle Scholar
  23. 23.
    Alexander KP, Chen AY, Roe MT, Newby LK, Gibson CM, Allen-LaPointe NM, Pollack C, Gibler WB, Ohman EM, Peterson ED, CRUSADE Investigators. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA. 2005;294:3108–16.CrossRefPubMedGoogle Scholar
  24. 24.
    Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, Jaffe AS, Jneid H, Kelly RF, Kontos MC, Levine GN, Liebson PR, Mukherjee D, Peterson ED, Sabatine MS, Smalling RW, Zieman SJ, American College of Cardiology, American Heart Association Task Force on Practice Guidelines, Society for Cardiovascular Angiography, Interventions, Society of Thoracic Surgeons, American Association for Clinical C 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139–228.Google Scholar
  25. 25.
    Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H, SYNERGY Trial Investigators. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;292:45–54.PubMedGoogle Scholar
  26. 26.
    Montalescot G, Zeymer U, Silvain J, Boulanger B, Cohen M, Goldstein P, Ecollan P, Combes X, Huber K, Pollack C, Jr., Benezet JF, Stibbe O, Filippi E, Teiger E, Cayla G, Elhadad S, Adnet F, Chouihed T, Gallula S, Greffet A, Aout M, Collet JP, Vicaut E, ATOLL Investigators. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 2011;378:693-703.Google Scholar
  27. 27.
    Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM, for the ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–16.CrossRefPubMedGoogle Scholar
  28. 28.
    Lincoff AM, Kleiman NS, Kereiakes DJ, Feit F, Bittl JA, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ, REPLACE Investigators. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA. 2004;292:696–703.CrossRefPubMedGoogle Scholar
  29. 29.
    Steg PG, van ‘t Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P, Ten Berg J, Van Grunsven P, Eggink GJ, Nibbe L, Zeymer U, Campo dell’ Orto M, Nef H, Steinmetz J, Soulat L, Huber K, Deliargyris EN, Bernstein D, Schuette D, Prats J, Clayton T, Pocock S, Hamon M, Goldstein P, EUROMAX Investigators. Bivalirudin started during emergency transport for primary PCI. N Engl J Med. 2013;369:2207–17.CrossRefPubMedGoogle Scholar
  30. 30.
    Cavender MA, Sabatine MS. Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. Lancet. 2014;384:599–606.CrossRefPubMedGoogle Scholar
  31. 31.
    Singh M. Bleeding avoidance strategies during percutaneous coronary interventions. J Am Coll Cardiol. 2015;65:2225–38.CrossRefPubMedGoogle Scholar
  32. 32.
    Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators, Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006;354:1464–76.Google Scholar
  33. 33.
    Boersma E, Harrington RA, Moliterno DJ, White H, Theroux P, Van de Werf F, de Torbal A, Armstrong PW, Wallentin LC, Wilcox RG, Simes J, Califf RM, Topol EJ, Simoons ML. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002;359:189–98.CrossRefPubMedGoogle Scholar
  34. 34.
    Subherwal S, Peterson ED, Dai D, Thomas L, Messenger JC, Xian Y, Brindis RG, Feldman DN, Senter S, Klein LW, Marso SP, Roe MT, Rao SV. Temporal trends in and factors associated with bleeding complications among patients undergoing percutaneous coronary intervention: a report from the National Cardiovascular Data CathPCI Registry. J Am Coll Cardiol. 2012;59:1861–9.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Giugliano RP, White JA, Bode C, Armstrong PW, Montalescot G, Lewis BS, van ‘t Hof A, Berdan LG, Lee KL, Strony JT, Hildemann S, Veltri E, Van de Werf F, Braunwald E, Harrington RA, Califf RM, Newby LK, EARLY ACS Investigators. Early versus delayed, provisional eptifibatide in acute coronary syndromes. N Engl J Med. 2009;360:2176–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Authors/Task Force Members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Juni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.Google Scholar
  37. 37.
    Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM, TRITON–TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.CrossRefPubMedGoogle Scholar
  38. 38.
    Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW, Price MJ, Leonardi S, Gallup D, Bramucci E, Radke PW, Widimsky P, Tousek F, Tauth J, Spriggs D, McLaurin BT, Angiolillo DJ, Genereux P, Liu T, Prats J, Todd M, Skerjanec S, White HD, Harrington RA, for the CHAMPION PHOENIX Investigators. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368:1303–13.CrossRefPubMedGoogle Scholar
  39. 39.
    Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S, Baumgartner H, Gaemperli O, Achenbach S, Agewall S, Badimon L, Baigent C, Bueno H, Bugiardini R, Carerj S, Casselman F, Cuisset T, Erol C, Fitzsimons D, Halle M, Hamm C, Hildick-Smith D, Huber K, Iliodromitis E, James S, Lewis BS, Lip GY, Piepoli MF, Richter D, Rosemann T, Sechtem U, Steg PG, Vrints C, Luis Zamorano J. Management of acute coronary syndromes in patients presenting without persistent STSEotESoC. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.CrossRefPubMedGoogle Scholar
  40. 40.
    Abbas AE, Brodie B, Dixon S, Marsalese D, Brewington S, O'Neill WW, Grines LL, Grines CL. Incidence and prognostic impact of gastrointestinal bleeding after percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2005;96:173–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Nikolsky E, Stone GW, Kirtane AJ, Dangas GD, Lansky AJ, McLaurin B, Lincoff AM, Feit F, Moses JW, Fahy M, Manoukian SV, White HD, Ohman EM, Bertrand ME, Cox DA, Mehran R. Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol. 2009;54:1293–302.CrossRefPubMedGoogle Scholar
  42. 42.
    Gaglia MA Jr, Torguson R, Gonzalez MA, Ben-Dor I, Maluenda G, Collins SD, Syed AI, Delhaye C, Wakabayashi K, Belle L, Mahmoudi M, Hanna N, Xue Z, Kaneshige K, Suddath WO, Kent KM, Satler LF, Pichard AD, Waksman R. Correlates and consequences of gastrointestinal bleeding complicating percutaneous coronary intervention. Am J Cardiol. 2010;106:1069–74.CrossRefPubMedGoogle Scholar
  43. 43.
    Kelly JP, Kaufman DW, Jurgelon JM, Sheehan J, Koff RS, Shapiro S. Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet. 1996;348:1413–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Lanas A, Scheiman J. Low-dose aspirin and upper gastrointestinal damage: epidemiology, prevention and treatment. Curr Med Res Opin. 2007;23:163–73.CrossRefPubMedGoogle Scholar
  45. 45.
    Grove EL, Wurtz M, Schwarz P, Jorgensen NR, Vestergaard P. Gastrointestinal events with clopidogrel: a nationwide population-based cohort study. J Gen Intern Med. 2013;28:216–22.CrossRefPubMedGoogle Scholar
  46. 46.
    Koskinas KC, Raber L, Zanchin T, Wenaweser P, Stortecky S, Moschovitis A, Khattab AA, Pilgrim T, Blochlinger S, Moro C, Juni P, Meier B, Heg D, Windecker S. Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions. Circ Cardiovasc Interv. 2015;8:e002053.CrossRefPubMedGoogle Scholar
  47. 47.
    Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ, Shook TL, Lapuerta P, Goldsmith MA, Laine L, Scirica BM, Murphy SA, Cannon CP, COGENT Investigators. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010;363:1909–17.CrossRefPubMedGoogle Scholar
  48. 48.
    Agewall S, Cattaneo M, Collet JP, Andreotti F, Lip GY, Verheugt FW, Huber K, Grove EL, Morais J, Husted S, Wassmann S, Rosano G, Atar D, Pathak A, Kjeldsen K, Storey RF. Pharmacology ESCWGoC, Drug Therapy, Thrombosis ESCWGo. Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J. 2013;34:1708–13, 1713a–1713bGoogle Scholar
  49. 49.
    Sung JJ, Lau JY, Ching JY, Wu JC, Lee YT, Chiu PW, Leung VK, Wong VW, Chan FK. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med. 2010;152:1–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Cappell MS. Safety and efficacy of colonoscopy after myocardial infarction: an analysis of 100 study patients and 100 control patients at two tertiary cardiac referral hospitals. Gastrointest Endosc. 2004;60:901–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Badar A, Scaife J, Yan AT, Robinson SD, Zaman AG, Purcell IF, Ahmed JM, Egred M, Edwards RJ, Spyridopoulos I, Keavney BD, Bagnall AJ. Provision of gastroprotective medication and bleeding risk following acute coronary syndrome. J Invasive Cardiol. 2013;25:397–401.PubMedGoogle Scholar
  52. 52.
    Ng FH, Chan P, Kwanching CP, Loo CK, Cheung TK, Wong SY, Kng C, Ng KM, Lai ST, Wong BC. Management and outcome of peptic ulcers or erosions in patients receiving a combination of aspirin plus clopidogrel. J Gastroenterol. 2008;43:679–86.CrossRefPubMedGoogle Scholar
  53. 53.
    Steg PG, Huber K, Andreotti F, Arnesen H, Atar D, Badimon L, Bassand JP, De Caterina R, Eikelboom JA, Gulba D, Hamon M, Helft G, Fox KA, Kristensen SD, Rao SV, Verheugt FW, Widimsky P, Zeymer U, Collet JP. Bleeding in acute coronary syndromes and percutaneous coronary interventions: position paper by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J. 2011;32:1854–64.CrossRefPubMedGoogle Scholar
  54. 54.
    Kralev S, Schneider K, Lang S, Suselbeck T, Borggrefe M. Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography. PLoS One. 2011;6:e24964.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Dewilde WJ, Janssen PW, Verheugt FW, Storey RF, Adriaenssens T, Hansen ML, Lamberts M, Ten Berg JM. Triple therapy for atrial fibrillation and percutaneous coronary intervention: a contemporary review. J Am Coll Cardiol. 2014;64:1270–80.CrossRefPubMedGoogle Scholar
  56. 56.
    Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP, Adriaenssens T, Vrolix M, Heestermans AA, Vis MM, Tijsen JG, van ‘t Hof AW, ten Berg JM, WOEST Study Investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381:1107–15.CrossRefPubMedGoogle Scholar
  57. 57.
    Fiedler KA, Maeng M, Mehilli J, Schulz-Schupke S, Byrne RA, Sibbing D, Hoppmann P, Schneider S, Fusaro M, Ott I, Kristensen SD, Ibrahim T, Massberg S, Schunkert H, Laugwitz KL, Kastrati A, Sarafoff N. Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation: the ISAR-TRIPLE trial. J Am Coll Cardiol. 2015;65:1619–29.CrossRefPubMedGoogle Scholar
  58. 58.
    Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GY, Cohen M, Husted S, Peterson ED, Fox KA. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016;375:2423–34.CrossRefPubMedGoogle Scholar
  59. 59.
    Sarafoff N, Martischnig A, Wealer J, Mayer K, Mehilli J, Sibbing D, Kastrati A. Triple therapy with aspirin, prasugrel, and vitamin K antagonists in patients with drug-eluting stent implantation and an indication for oral anticoagulation. J Am Coll Cardiol. 2013;61:2060–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR, RIVAL Trial Group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377:1409–20.CrossRefPubMedGoogle Scholar
  61. 61.
    Karrowni W, Vyas A, Giacomino B, Schweizer M, Blevins A, Girotra S, Horwitz PA. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2013;6:814–23.CrossRefPubMedGoogle Scholar
  62. 62.
    Bernat I, Horak D, Stasek J, Mates M, Pesek J, Ostadal P, Hrabos V, Dusek J, Koza J, Sembera Z, Brtko M, Aschermann O, Smid M, Polansky P, Al Mawiri A, Vojacek J, Bis J, Costerousse O, Bertrand OF, Rokyta R. ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial. J Am Coll Cardiol. 2014;63:964–72.CrossRefPubMedGoogle Scholar
  63. 63.
    Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44–122.Google Scholar
  64. 64.
    Sanborn TA, Ebrahimi R, Manoukian SV, McLaurin BT, Cox DA, Feit F, Hamon M, Mehran R, Stone GW. Impact of femoral vascular closure devices and antithrombotic therapy on access site bleeding in acute coronary syndromes: The Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Circ Cardiovasc Interv. 2010;3:57–62.CrossRefPubMedGoogle Scholar
  65. 65.
    Schulz-Schupke S, Helde S, Gewalt S, Ibrahim T, Linhardt M, Haas K, Hoppe K, Bottiger C, Groha P, Bradaric C, Schmidt R, Bott-Flugel L, Ott I, Goedel J, Byrne RA, Schneider S, Burgdorf C, Morath T, Kufner S, Joner M, Cassese S, Hoppmann P, Hengstenberg C, Pache J, Fusaro M, Massberg S, Mehilli J, Schunkert H, Laugwitz KL, Kastrati A. Instrumental sealing of arterial puncture site CDvMCTI. Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR-CLOSURE randomized clinical trial. JAMA. 2014;312:1981–7.CrossRefPubMedGoogle Scholar
  66. 66.
    Amlani S, Nadarajah T, Afzal R, Pal-Sayal R, Eikelboom JW, Natarajan MK. Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction. J Thromb Thrombolysis. 2010;30(4):434–40.CrossRefPubMedGoogle Scholar
  67. 67.
    Matic DM, Milasinovic DG, Asanin MR, Mrdovic IB, Marinkovic JM, Kocev NI, Marjanovic MM, Antonijevic NM, Vukcevic VD, Savic LZ, Zivkovic MN, Mehmedbegovic ZH, Dedovic VM, Stankovic GR. Prognostic implications of bleeding measured by Bleeding Academic Research Consortium (BARC) categorisation in patients undergoing primary percutaneous coronary intervention. Heart. 2014;100(2):146–52.CrossRefPubMedGoogle Scholar
  68. 68.
    Moscucci M, Fox KA, Cannon CP, Klein W, Lopez-Sendon J, Montalescot G, White K, Goldberg RJ. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2003;24(20):1815–23.CrossRefPubMedGoogle Scholar
  69. 69.
    Kinnaird TD, Stabile E, Mintz GS, Lee CW, Canos DA, Gevorkian N, Pinnow EE, Kent KM, Pichard AD, Satler LF, Weissman NJ, Lindsay J, Fuchs S. Incidence, predictors, and prognostic implications of bleeding and blood transfusion following percutaneous coronary interventions. Am J Cardiol. 2003;92(8):930–5.CrossRefPubMedGoogle Scholar
  70. 70.
    Chhatriwalla AK, Amin AP, Kennedy KF, House JA, Cohen DJ, Rao SV, Messenger JC, Marso SP, National Cardiovascular Data R. Association between bleeding events and in-hospital mortality after percutaneous coronary intervention. JAMA. 2013;309(10):1022–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Lindsey JB, Marso SP, Pencina M, Stolker JM, Kennedy KF, Rihal C, Barsness G, Piana RN, Goldberg SL, Cutlip DE, Kleiman NS, Cohen DJ, Investigators ER. Prognostic impact of periprocedural bleeding and myocardial infarction after percutaneous coronary intervention in unselected patients: results from the EVENT (evaluation of drug-eluting stents and ischemic events) registry. JACC Cardiovasc Interv. 2009;2(11):1074–82.CrossRefPubMedGoogle Scholar
  72. 72.
    Schulz S, Mehilli J, Ndrepepa G, Neumann FJ, Birkmeier KA, Kufner S, Richardt G, Berger PB, Schomig A, Kastrati A. Intracoronary S and antithrombotic regimen: rapid early action for Coronary Treatment 3 Trial I. Bivalirudin vs. unfractionated heparin during percutaneous coronary interventions in patients with stable and unstable angina pectoris: 1-year results of the ISAR-REACT 3 trial. Eur Heart J. 2010;31(5):582–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Mehran R, Pocock SJ, Nikolsky E, Clayton T, Dangas GD, Kirtane AJ, Parise H, Fahy M, Manoukian SV, Feit F, Ohman ME, Witzenbichler B, Guagliumi G, Lansky AJ, Stone GW. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556–66.CrossRefPubMedGoogle Scholar
  74. 74.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK, the CURE investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. New Engl J Med. 2001;345(7):494–502.CrossRefPubMedGoogle Scholar
  75. 75.
    CURRENT-OASIS 7 Investigators, Mehta SR, Bassand JP, Chrolavicius S, Diaz R, Eikelboom JW, Fox KA, Granger CB, Jolly S, Joyner CD, Rupprecht HJ, Widimsky P, Afzal R, Pogue J, Yusuf S. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. New Engl J Med. 2010;363(10):930–42.CrossRefGoogle Scholar
  76. 76.
    Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, Topol EJ, CREDO Investigators. Clopidogrel for the reduction of events during observation. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;288(19):2411–20.CrossRefPubMedGoogle Scholar
  77. 77.
    Montalescot G, Bolognese L, Dudek D, Goldstein P, Hamm C, Tanguay JF, ten Berg JM, Miller DL, Costigan TM, Goedicke J, Silvain J, Angioli P, Legutko J, Niethammer M, Motovska Z, Jakubowski JA, Cayla G, Visconti LO, Vicaut E, Widimsky P, Investigators A. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. New Engl J Med. 2013;369(11):999–1010.CrossRefPubMedGoogle Scholar
  78. 78.
    Montalescot G, van’t Hof AW, Lapostolle F, Silvain J, Lassen JF, Bolognese L, Cantor WJ, Cequier A, Chettibi M, Goodman SG, Hammett CJ, Huber K, Janzon M, Merkely B, Storey RF, Zeymer U, Stibbe O, Ecollan P, Heutz WM, Swahn E, Collet JP, Willems FF, Baradat C, Licour M, Tsatsaris A, Vicaut E, Hamm CW, Investigators A. Prehospital ticagrelor in ST-segment elevation myocardial infarction. New Engl J Med. 2014;371(11):1016–27.CrossRefPubMedGoogle Scholar
  79. 79.
    Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, Andersen HR, Betriu A, Savonitto S, Adamus J, Peruga JZ, Kosmider M, Katz O, Neunteufl T, Jorgova J, Dorobantu M, Grinfeld L, Armstrong P, Brodie BR, Herrmann HC, Montalescot G, Neumann FJ, Effron MB, Barnathan ES, Topol EJ, Investigators F. Facilitated PCI in patients with ST-elevation myocardial infarction. New Engl J Med. 2008;358(21):2205–17.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular InstituteNew YorkUSA

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