A-51 | Major Bleeding Complications in Chronic Kidney Disease Patients Undergoing Percutaneous Coronary Intervention: Does Access Site or Anticoagulant Choice Matter More?

Abstract

Data on anticoagulant (AC) use in chronic kidney disease (CKD) patients (pts) undergoing percutaneous coronary intervention (PCI) is scarce. Unfractionated heparin (UFH) or bivalirudin are treatments of choice. We assessed major bleeding and major adverse cardiac and cerebrovascular events (MACCE) in CKD (eGFR<60 mL/min/1.73 m2) pts undergoing PCI with either UFH or Bivalirudin and whether femoral vs. radial access modified the relationship of AC choice and outcomes. Data was collected on all CKD pts who underwent PCI from 2010 to 2018. Bleeding was classified by Bleeding Academic Research Consortium (BARC) criteria. BARC 4 and 5 were excluded. A total of 3844 pts had femoral access and 1,421 pts had radial access; 2533 pts got UFH and 2732 pts got bivalirudin (Table). Bivalirudin was used in 68% of femoral access and 7.5% of radial access. Among femoral access pts, the odds of major bleeding (BARC≥3) were greater among UFH pts compared to bivalirudin pts (OR: 1.8, CI:1.4-2.4). An interaction existed between AC and access site for odds of MACCE (p=0.02) but not for odds of BARC≥3. Among femoral access pts, no effect of AC on MACCE was found, but among radial access pts, odds of MACCE were higher for bivalirudin pts compared to UFH pts (OR 2.0, CI:1.1-3.5). To summarize: 1) bivalirudin was used in the majority of pts undergoing femoral access PCI; 2) Among femoral access pts, the choice of AC had no impact on the odds of MACCE but the odds of BARC≥3 were greater in pts treated with UFH vs. pts treated with Bivalirudin; 3) Among radial access pts, the odds of MACCE were greater in pts treated with bivalirudin vs. pts treated with UFH.