• Stacie L Daugherty, Lauren E Thompson, Sunghee Kim, Sunil V Rao, Sumeet Subherwal, Thomas T Tsai, John C Messenger, and Frederick A Masoudi.
• Department of Medicine and the Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA. stacie.daugherty@ucdenver.edu
• J. Am. Coll. Cardiol. 2013 May 21;61(20):2070-8.

ObjectivesThis study sought to compared the use and effectiveness of bleeding avoidance strategies (BAS) by sex.BackgroundWomen have higher rates of bleeding following percutaneous coronary intervention (PCI).MethodsAmong 570,777 men (67.5%) and women (32.5%) who underwent PCI in the National Cardiovascular Data Registry's CathPCI Registry between July 1, 2009 and March 31, 2011, in-hospital bleeding rates and the use of BAS (vascular closure devices, bivalirudin, radial approach, and their combinations) were assessed. The relative risk of bleeding for each BAS compared with no BAS was determined in women and men using multivariable logistic regressions adjusted for clinical characteristics and the propensity for receiving BAS. Finally, the absolute risk differences in bleeding associated with BAS were compared.ResultsOverall, the use of any BAS differed slightly between women and men (75.4% vs. 75.7%, p = 0.01). When BAS was not used, women had significantly higher rates of bleeding than men (12.5% vs. 6.2%, p < 0.01). Both sexes had similar adjusted risk reductions of bleeding when any BAS was used (women, odds ratio: 0.60, 95% confidence interval [CI]: 0.57 to 0.63; men, odds ratio: 0.62, 95% CI: 0.59 to 0.65). Women and men had lower absolute bleeding risks with BAS; however, these absolute risk differences were greater in women (6.3% vs. 3.2%, p < 0.01).ConclusionsWomen continue to have almost twice the rate of bleeding following PCI. The use of any BAS was associated with a similarly lower risk of bleeding for men and women; however, the absolute risk differences were substantially higher in women. These data underscore the importance of applying effective strategies to limit post-PCI bleeding, especially in women.Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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