A Retrospective Study on the Use of Heparin for Peripheral Vascular Intervention

Walker, Stuart; Beasley, Charles W.; Reeves, Mark

doi:10.1177/1531003512459889

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…In comparison, access site complication occurred in 7.0% and 8.9% of patients in prior PVI studies. 5,6 The small sample sizes and difference in access site bleeding definitions used in the previous studies may account for the difference in complication rates.…”

Section: Discussionmentioning

confidence: 99%

Access Site Complications After Peripheral Vascular Interventions

Ortiz

Jahangir

Singh

et al. 2014

Circ: Cardiovascular Interventions

103

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Background Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear. Methods and Results We retrospectively analyzed data from the multicenter Vascular Quality Initiative® on 22,226 patients who underwent 27,048 PVI from August 2007 to May 2013. Primary endpoints included incidence and predictors of access site complications (ASC), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female gender, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and urgent indication. Mean hospitalization was longer after procedures complicated by ASC (1.2 ± 1.6 days vs. 1.9 ± 1.9 days; range 0-7 days; p=0.002). Severity of ASC correlated with higher rates of discharge to rehabilitation/nursing facilities compared to home discharge. Patients with severe ASC had higher 30-day mortality (6.1% vs. 1.4%; p<0.001), and those with moderate ASC requiring transfusion had elevated 1-year mortality (12.1%, vs. 5.7%; p<0.001). Conclusions Several factors independently predict access site complication following peripheral vascular intervention. Appropriate use of antithrombotic therapies and vascular closure device in patients at increased risk of ASC may improve post-PVI outcomes.

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Section: Discussionmentioning

confidence: 99%

Access Site Complications After Peripheral Vascular Interventions

Ortiz

Jahangir

Singh

et al. 2014

Circ: Cardiovascular Interventions

103

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“…Following analysis of the huge Vascular Quality Initiative database (~28,000 patients at 131 centers), Ortiz and colleagues 34 reported similar access site complication rates (3.4%), while again female sex and age >70 years were correlated with access site complications. The authors proposed and validated a score using 7 parameters to stratify patients as low (score 0-15), intermediate (score [16][17][18][19][20][21][22][23][24][25][26][27], or high (score 28-42) risk. However, this score investigated only access site-related complications and therefore cannot be used for the evaluation of all periprocedural bleeding complications, as the proposed PBS.…”

Section: Discussionmentioning

confidence: 99%

“…The access site–related major complication rate in this study matched the 3% safety threshold recommended by the Society of Interventional Radiology 20 and was lower than the reported rates (7% to 11.5%) from previous studies. 21–23 However, in the largest available retrospective analysis, which included 27,048 peripheral vascular interventions from the multicenter Vascular Quality Initiative, 12 major access site–related complications requiring treatment were identified in only 0.9% of the cases. This discrepancy could be attributed not only to the significantly larger sample size but also to the fact that some complications might have been missed in a retrospective data analysis.…”

Section: Discussionmentioning

confidence: 99%

A New Preprocedural Score to Predict Bleeding Complications of Endovascular Interventions for Peripheral Artery Disease

et al. 2019

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Purpose: To investigate the bleeding complications associated with endovascular therapy (EVT) for peripheral artery disease (PAD) and develop a dedicated peripheral bleeding score (PBS). Materials and Methods: This prospective, single-center study enrolled 530 patients (mean age 67.6±9.8 years; 396 men) undergoing endovascular procedures between August 2016 and July 2018 for chronic PAD. Primary endpoints were the incidence of 30-day bleeding complications [minor and major (prolonging hospitalization, causing permanent sequelae, or resulting in death)], the identification of factors associated with bleeding events, and the development of a dedicated PBS based on univariate and multivariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. The HAS-BLED score was compared with the PBS. Results: The overall peripheral bleeding complication rate was 3.8% (20/530), of which 3.2% (17/530) were major and included 4 (0.7%) active retroperitoneal bleeding events and 13 (2.4%) pseudoaneurysms. The annualized incidences of overall bleeding and major bleeding complications were 1.9% and 1.6%, respectively. Multivariable regression analysis identified age ≥75 as a correlate of significantly increased bleeding risk (HR 3.32, 95% CI 1.12 to 9.80, p<0.02). Male gender (HR 0.193, 95% CI 0.49 to 0.75, p<0.001) and statin therapy (HR 0.245, 95% CI 0.08 to 0.71, p=0.01) were correlated with a significantly decreased bleeding risk. Based on the regression analysis findings an 8-point PBS was developed, demonstrating 75.0% sensitivity and 78.4% specificity in detecting bleeding complications. The HAS-BLED score failed to identify 30-day bleeding events. Conclusion: The annualized incidence of bleeding complications associated with peripheral EVT was low. Advanced age and female sex were correlated with increased bleeding risk. The PBS demonstrated satisfactory statistical performance and could be considered for inclusion in the preprocedural endovascular checklist to help optimize intra- and postprocedural care.

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“…The concomitant use of acetyl-salicylic-acid (ASA) increased the incidence of bleeding complications in the heparin group, but not in the enoxaparin group. In 2012, a retrospective evaluation of using heparin or no heparin during peripheral interventions was published [ 30 ]. Results were described for 220 arterial procedures with the use of a bolus of heparin and 110 in which no bolus of heparin was administered.…”

Section: Heparin In Flushing Solution and As Bolusmentioning

confidence: 99%

The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis

et al. 2016

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A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.

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A Retrospective Study on the Use of Heparin for Peripheral Vascular Intervention

Abstract: In this study, heparin use and nonuse of a closure or compression device was associated with an increased risk of access site bleeding. Embolic/thrombotic complications were uncommon.

Cited by 7 publications

References 10 publications

Access Site Complications After Peripheral Vascular Interventions

Access Site Complications After Peripheral Vascular Interventions

A New Preprocedural Score to Predict Bleeding Complications of Endovascular Interventions for Peripheral Artery Disease

The Use of Heparin during Endovascular Peripheral Arterial Interventions: A Synopsis

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