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Overview :
Kinnaird et al identified risk factors for major blood loss
and for blood transfusion following a percutaneous coronary intervention (PCI).
These can help identify patients who may benefit from more aggressive
management. The authors are from Washington Hospital Center (Washington, D.C.),
Cardiovascular Research Foundation (NYC) and Rabin Medical Center (Israel).
The TIMI criteria were used to define major and minor
bleeding (see Section 06.09.14).
Risk factors for major bleeding:
(1) age > 80 years
(2) use of an intra-aortic balloon pump (IABP)
(3) hypotension during the procedure
The presence a major bleed associated with PCI was associated
with an increased risk for
in-hospital and 1 year mortality. The occurrence of a stroke had the
highest odds ratio for in-hospital and 1 year mortality.
Risk factors for receiving a blood transfusion:
(1)
retroperitoneal bleeding
(2)
gastrointestinal bleeding (with gross hematemesis, heme-positive coffee ground
emesis, or heme-positive melena)
(3) large
hematoma (palpable swlelling >= 4 cm in diameter) at arterial access site
(4) age
> 80 years
where:
• The first 3 items for predicting blood transfusion are the
criteria for clinical bleeding.
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