{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T07:18:48Z","timestamp":1774595928934,"version":"3.50.1"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,11,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Bleeding remains the most common complication of percutaneous coronary intervention. Guidelines recommend assessing bleeding risk before percutaneous coronary intervention to target use of bleeding avoidance strategies and mitigate bleeding events. Cedars\u2010Sinai Medical Center undertook an initiative to integrate these recommendations into the electronic medical record.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The intervention included a voluntary clinical decision alert to assess bleeding risk before percutaneous coronary intervention, a bleeding risk calculator tool based on the\n              <jats:styled-content style=\"fixed-case\">NCDR<\/jats:styled-content>\n              (National Cardiovascular Data Registry) risk prediction model and, when indicated, a second alert to consider 4 bleeding avoidance strategies. We tested for changes in the use of bleeding avoidance strategies and bleeding event rates by comparing procedures performed before versus after implementation of the electronic medical record\u2013based intervention and with versus without use of the bleeding risk calculator tool. Use of radial access increased (47.6% versus 64.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and glycoprotein\n              <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n              b\/\n              <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n              a inhibitors decreased (12.8% versus 3.17%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) from before to after implementation, though risk\u2010adjusted bleeding event rates were stable (\n              <jats:styled-content style=\"fixed-case\">odds ratio,<\/jats:styled-content>\n              0.82;\n              <jats:italic>P<\/jats:italic>\n              =0.164), even for high\u2010risk procedures. Use versus nonuse of the bleeding risk calculator tool was associated with increased radial access and reductions in glycoprotein\n              <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>\n              b\/\n              <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content>\n              a inhibitors, but no change in bleeding events.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Integrating guideline recommendations into the electronic medical record to promote assessments of bleeding risk and use of bleeding avoidance strategies was feasible and associated with changes in clinical practice. Future work is needed to ensure that bleeding avoidance strategies are not overused among lower\u2010risk patients, and that, for high\u2010risk patients, the potential benefits of elective percutaneous coronary intervention are carefully weighed against the risk of bleeding.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.013954","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T10:02:47Z","timestamp":1573466567000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Development and Evaluation of Novel Electronic Medical Record Tools For Avoiding Bleeding After Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"8","author":[{"given":"Joseph","family":"Ebinger","sequence":"first","affiliation":[{"name":"Cedars\u2010Sinai Smidt Heart Institute Los Angeles CA"},{"name":"Department of Medicine Cedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Henry","sequence":"additional","affiliation":[{"name":"Christ Hospital Heart and Vascular Center Cincinnati OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sungjin","family":"Kim","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics Research Center Cedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moira","family":"Inkelas","sequence":"additional","affiliation":[{"name":"Fielding School of Public Health University of California Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Cheng","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Smidt Heart Institute Los Angeles CA"},{"name":"Department of Medicine Cedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teryl","family":"Nuckols","sequence":"additional","affiliation":[{"name":"Department of Medicine Cedars\u2010Sinai Medical Center Los Angeles CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000152"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.01.033"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.20238"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2013-000021"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.09.076"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm194"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.12.045"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm004"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31823ba622"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.708"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.000279"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.04.031"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60292-6"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.10.003"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001275"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm084"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.15.1458"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-418"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.108.846741"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.111.964791"},{"key":"e_1_3_1_22_2","unstructured":"NCDR CathPCI Registry v4.4 Coder's Data Dictionary. 2011. 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