NEW YORK (Reuters Health) – Decreases in hemoglobin after transradial percutaneous coronary intervention (PCI) are minor in most patients, researchers from Quebec Heart-Lung Institute report in the July 15th American Journal of Cardiology.

Few data have been reported on the changes in hemoglobin after PCI using the femoral approach, the investigators note, and none have been published for the transradial approach.

Dr. Olivier F. Bertrand and colleagues from Quebec Heart-Lung Institute, Quebec, Quebec, Canada assessed the incidence, range, and clinical effects of hemoglobin changes after transradial coronary stenting and maximal antiplatelet therapy in a post hoc analysis of data from the EArly Discharge After Transradial Stenting of CoronarY Arteries (EASY) trial of 1348 patients.

Two hundred six (15%) of patients met the WHO definition of anemia before PCI and 410 (30%) met the definition of anemia within 24 hours after PCI, with significantly more women than men having anemia before (23% versus 13%) and after (44% versus 26%) PCI.

There was a mean overall decrease on hemoglobin of 0.6 g/dL within 24 hours after PCI. However, 27% of patients had no hemoglobin decrease and 41% had a decrease of no more than 1 g/dL. [

Another 24% of patients had a decrease in hemoglobin between 1 and 2 g/dL, 7% had a decrease between 2 and 3 g/dL, and only 1.3% had a decrease in excess of 3 g/dL.

“Other studies using standard femoral approach have found a hematocrit decrease of 5% to 15% after percutaneous transluminal coronary angioplasty and 21% after coronary stenting,” the authors note. “From our results, transradial PCI seems to limit the periprocedural hemoglobin decrease, because the mean decrease the day after the procedure was limited, with 68% of patients having no hemoglobin decrease or no more than 1 g/dL.”

There was a clear cutoff in the significant increase in major adverse coronary events (MACE) when the hemoglobin decrease exceeded 3 g/dL, leading investigators to conclude that “a hemoglobin decrease above 3 g/dL after PCI as a cutoff value for current definitions of major bleeding in modern PCI trials appears reasonable.”

On multivariate analysis, anemia within 24 hours after PCI independently predicted MACE up to 3 years after PCI. In sharp contrast to other studies, however, anemia within 24 hours after PCI did not predict early or late mortality.

Because these findings derive from a post hoc analysis, the researchers caution, “our findings should primarily be viewed as hypothesis generating.”

“Measures to prevent anemia and blood loss during PCI remain to be further studied,” they add.

Reference:

Incidence, Range, and Clinical Effect of Hemoglobin Changes Within 24 Hours After Transradial Coronary Stenting

Am J Cardiol 2010;106:155-161.