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Chronic Limb-Threatening Ischemia is a Residual Bleeding Risk Factor among Patients with Lower Extremity Artery
Takahiro Tokuda1, Naoki Yoshioka2, Akio Koyama3
1Department of Cardiology, Nagoya Heart Center.
Insights
Chronic limb-threatening ischemia (CLTI) is a significant predictor of bleeding in patients with lower-extremity artery disease (LEAD) undergoing endovascular treatment (EVT). Careful monitoring for bleeding events in CLTI patients post-EVT is crucial.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Patient Safety
Background:
- Lower-extremity artery disease (LEAD) is a known risk factor for bleeding complications.
- Specific risk factors for bleeding in LEAD patients post-endovascular treatment (EVT) require further elucidation.
Purpose of the Study:
- To identify and analyze the risk factors associated with bleeding in patients diagnosed with LEAD who have undergone EVT.
- To specifically investigate the role of chronic limb-threatening ischemia (CLTI) as a bleeding risk factor.
Main Methods:
- A multicenter, retrospective, observational study involving 732 patients with LEAD who underwent EVT.
- Comparison of patient characteristics, laboratory data, lesion details, and medications between patients with and without CLTI.
- Application of Cox regression analysis to determine predictive bleeding risk factors.
Main Results:
- Underweight (BMI <18.5 kg/m²), prior heart failure, high bleeding risk, and combined antiplatelet/warfarin therapy were significant bleeding predictors.
- Anemia, low platelet count, chronic kidney disease, and CLTI were identified as independent risk factors for bleeding post-EVT.
- CLTI emerged as a consistent and significant predictor of bleeding events.
Conclusions:
- Chronic limb-threatening ischemia (CLTI) is a critical residual and predictive risk factor for bleeding in patients with LEAD after EVT.
- Increased vigilance and monitoring for bleeding complications are essential for patients with CLTI following EVT.
Aim:
Lower-extremity artery disease (LEAD) is a high-risk factor for bleeding. However, the specific risk factors for bleeding in patients with LEAD remain unclear. We aimed to identify risk factors for bleeding in patients with LEAD after endovascular treatment (EVT).
Methods:
This multicenter, retrospective, observational study included 732 consecutive patients with LEAD who underwent EVT between January 2018 and December 2019. Patient characteristics, laboratory data, target lesions, and medications were compared between patients with and without chronic limb-threatening ischemia (CLTI). Predictive bleeding risk factors were explored using Cox regression analysis with differential models.
Results:
In model 1, a body mass index (BMI) ＜18.5 kg/m2, prior heart failure, high bleeding risk, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were predictive bleeding risk factors (hazard ratio [HR] 2.05; 95% confidence interval [CI] 1.13-3.52; p＜0.01; HR 2.15; 95% CI 1.28-3.55; p＜0.01; HR 3.40; 95% CI 1.28-3.55; p＜0.01; HR 2.05; 95% CI 1.33-5.84; p＜0.01; respectively). In model 2, a BMI ＜18.5 kg/m2, prior heart failure, anemia (＜11 g/dL), low platelet count (＜10*104/µL), chronic kidney disease, use of single antiplatelet therapy (SAPT) plus warfarin, and CLTI were independent risk factors for bleeding (model 2: HR 2.05; 95% CI 1.12-3.56; p=0.02; HR 2.35; 95% CI 1.39-3.90; p＜0.01; HR 2.71; 95% CI 1.64-4.50; p＜0.01; HR 2.66; 95% CI 1.00-5.89; p=0.05; HR 2.47; 95% CI 1.25-5.45; p＜0.01; HR 2.79; 95% CI 1.24-5.63; p=0.01; respectively) Conclusions: CLTI is a residual and predictive risk factor for bleeding in patients with LEAD. We have to pay attention to the bleeding events of patients with CLTI after EVT during follow-up.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...