Critical Analysis of Potential Bleeding Complication in Patient Post Coronary Angioplasty

Running head: CRITICAL ANALYSIS
Critical analysis
Name of the student:
Name of the University:
Author’s note

1CRITICAL ANALYSIS
Identification of potential problem in patient:
Mrs. Elizabeth Green is a 78 year old woman, who had to undergo a coronary angioplasty
after she was admitted to hospital for central chest and left shoulder pain. The review of her
journey from pre-hospital to discharge post cardiac event suggest that the coronary angioplasty
was performed using a femoral artery approach and the blockage found in left artery was stented.
Coronary angiography is the gold standard test for the detection and diagnosis of coronary artery
disease. One of the potential problems that Mrs. Green can face post angiography includes
bleeding complication. Bleeding related problems can be seen in patient due to vascular access
site complications. It is the most challenging complications post coronary angiography and post
procedural bleeding increases length of stay and long-term survival rate for patient (Tavakol,
Ashraf and Brener 2012).
Rational for choosing potential problem in patient:
Bleeding has been specifically chosen as a problem for Mrs. Green because coronary
angioplasty was performed for her using the femoral artery approach. The femoral approach
technique is the most common approach to perform coronary angioplasty. This approach has
gained universal acceptance because of easy access and workforce experience (Nardin et al.
2018). However, the disadvantage of the femoral artery approach is that it increases risk of
vascular complication in patient. There is significant risk of vascular complication due to
transfemoral approach. This form of complication leads to deaths caused by major vascular
bleeding. Risk of bleeding also increases due to blood transfusion and vessel occlusion (Wu et al.
2015). Bleeding has been regarded as one potential problem for Mrs. Green because her
observations revealed 10-20% occlusion of cardiac vessels.

2CRITICAL ANALYSIS
Many research studies give the evidence regarding access site bleeding as the most
common vascular complication in femoral approach. As Mrs. Green is a 78 year old patient, she
is most prone to risk because of bleeding complication. Femoral artery is the most common
access vessel during angioplasty and vascular access process is optimized by the use of
ultrasound guidance and micropuncture needle. In case of angiography procedure, ideal entry
position is between the lateral circumflex artery and the femoral bifurcation. However, access
outside the zone increases the rate of access site complication (Kwok et al. 2015).
Shanmugam et al. (2017) explains that bleeding remains a problem after angioplasty
because of the use of anti-platelet and anti-thrombotic agents during the procedure. These agents
are given to patient to improve ischemic outcomes. However, it increases risk of access site
bleeding and bleeding in the gastrointestinal system and the central nervous system. If the patient
is older, the use of blood products increases compared to younger patient. Anti-platelet therapy is
regarded as one of the variable that increases bleeding or blood transfusion post angioplasty (Ho
and Mok, 2016). The dosage of anti-platelets given during the procedure may be a predictor of
bleeding. To reduce such complication, providing appropriate dosage of anti-platelet agents and
selection of anti-platelets based on individual risk for ischemic and bleeding complication is
needed for Mrs. Green (Numasawa et al. 2017).
The need for blood transfusion after bleeding problem also increases risk for Mrs. Green.
This can be said because of pro-inflammatory and thrombotic effects of red blood transfusion.
Doyle et al. (2008) suggest worst outcome in patient due to transfusion of more than 3 units.
Therefore, a causal relationship between post angioplasty blood transfusion and mortality is
evident. This evidence also suggests improvement in access strategies to prevent complication in
patients like Mrs. Green.