Factors related to a clinically silent peri-procedural drop in hemoglobin with coronary and peripheral vascular interventions

Vasc Med. 2011 Oct;16(5):354-9. doi: 10.1177/1358863X11417622.


Clinically evident and subclinical peri-procedural bleeding following interventional therapies are associated with adverse cardiovascular outcomes. The risk factors for clinically evident bleeding have been well described. Despite the well-documented association of adverse outcomes for patients with a subclinical peri-procedural hemoglobin drop, the clinical predictors have not yet been defined. We identified 1176 consecutive patients with a subclinical drop in hemoglobin (fall of ≥ 1 g/dl in patients without clinical bleeding) following percutaneous coronary interventions (PCI) and peripheral vascular interventions (PVI). Multivariate logistic regression analysis was performed. A subclinical peri-procedural hemoglobin drop ≥ 1 g/dl was identified in 41% (400/972) of PCI and in 49% (213/435) of PVI. More than one access site predicted a higher risk of a subclinical drop in hemoglobin in both groups. A body mass index ≥ 30 predicted a lower risk of a subclinical drop in hemoglobin in both groups. For PCI, creatinine clearance < 60 ml/min was associated with a higher risk of a subclinical drop in hemoglobin. In conclusion, clinically silent peri-procedural hemoglobin fall ≥ 1 g/dl is common in patients undergoing both coronary and peripheral percutaneous intervention. Predictors identified in our study will need prospective validation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Body Mass Index
  • Cohort Studies
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / therapy*
  • Creatinine / metabolism
  • Female
  • Hemoglobins / metabolism*
  • Humans
  • Kidney Failure, Chronic / metabolism
  • Male
  • Middle Aged
  • Peripheral Arterial Disease / blood
  • Peripheral Arterial Disease / therapy*
  • Postoperative Hemorrhage / blood
  • Postoperative Hemorrhage / etiology*
  • Retrospective Studies
  • Risk Factors


  • Hemoglobins
  • Creatinine