To the Editor: Dr Marso and colleagues1 demonstrated the association between the use of bleeding avoidance strategies (including use of bivalirudin and vascular closure devices) and reduced rates of periprocedural bleeding, using data from the National Cardiovascular Data Registry (NCDR) CathPCI Registry. Their analysis suggested that vascular closure device use significantly reduced bleeding events compared with manual compression in patients with intermediate or high preprocedural bleeding risk as estimated by a model derived from the CathPCI data. We believe the conclusions about the efficacy of vascular closure device use must be interpreted carefully.
Pei-Hsiu Huang, Alan Zajarias, John M. Lasala. Bleeding Avoidance Strategies and Percutaneous Coronary Intervention. JAMA. 2010;304(10):1068–1069. doi:10.1001/jama.2010.1255