Reversing the “Risk-Treatment Paradox” of Bleeding in Patients Undergoing Percutaneous Coronary Intervention: Risk-Concordant Use of Bleeding Avoidance Strategies is Associated with Reduced Bleeding and Lower Costs

December 2, 2019


Bleeding is a common, morbid, and costly complication of percutaneous coronary intervention, occurring in 2% to >10% of the more than 600,000 patients who undergo PCI each year. Bleeding event costs $8,000 to $12,000 per episode. This study examined the use of a patient-centric approach to specifically increase the risk-concordant use of BAS and investigated whether reversing the ‘risk-treatment paradox’ (a situation in which patients at high risk for adverse events receive less-intensive treatment than do patients at lower risk) is associated with reduced bleeding and associated costs.


The investigators implemented intervention to reverse the bleeding risk-treatment paradox at Barnes-Jewish Hospital, St. Louis, MO (USA) and examined: (1) the temporal trends in BAS use and (2) the association of risk-concordant BAS use with bleeding and hospital costs of PCI intervention.


Among 3519 percutaneous coronary interventions, there was a significantly increasing trend (P=0.002) in risk-concordant use of BAS. The bleeding incidence was 2% in the risk-concordant group versus 9% in the risk-discordant group (absolute risk difference, 7%; number NNT, 14). Risk-concordant BAS use was associated with a 67% (95% confidence interval, 52–78%; P<0.001) reduction in the risk of bleeding and a $4738 (95% CI, 3353–6122; P<0.001) reduction in per-patient PCI hospitalization costs (21.6% cost-savings).

Association of use of Risk-Concordant BAS with Occurrance of Bleeding

Trends in Risk-Concordant use of BAS


Patient-centric care based on the predicted risk of bleeding led to more risk-concordant use of BAS and reversal of the risk-treatment paradox. Such a personalized strategy was associated with a reduction in bleeding and costs of hospitalization. Both the patient and hospital (via substantial reduction in per-patient costs) are likely to benefit by a simple change of practice that encourages objectivity and minimizes variability in care.

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About the Author

Terumo Health Outcomes ℠

Sr. Strategic Business Account Manager
Terumo Health Outcomes


As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.