Vascular closure devices in patients treated with anticoagulation and iib/iiia receptor inhibitors during percutaneous revascularization

Abstract

Arterial closure following coronary interventions using anticoagulation and GP IIb/IIIa inhibitor therapy can be safely and effectively performed, with vascular complication rates similar to or lower than with manual pressure. Additionally, vascular complication rates using GP IIb/IIIa inhibitor therapy regardless of the method of arterial closure are equivalent to or lower than previously published rates of vascular complications.

Femoral Arterial Access and Closure

“…It involves a higher learning curve, has been shown to have a higher failure rate, 44,45 and results in a longer time to achieve hemostasis than the collagen plug-based (AngioSeal) device. 45 The device leaves behind a suture and hence could be a nidus for infection.…”

Relationship Between Femoral Vascular Closure Devices and Short-Term Mortality From 271 845 Percutaneous Coronary Intervention Procedures Performed in the United Kingdom Between 2006 and 2011

“…[5][6][7]45 In addition, the current results support previous studies demonstrating VCDs to be of greater value in patients receiving anticoagulant agents by reducing bleeding complications. [23][24][25][26][27][28] Conversely, although VCDs have been associated with life-threatening complications, 21,[30][31][32][33][34][35] this study did not demonstrate any signal of an adverse mortality impact in any of the prespecified subgroups, and indeed showed a more pronounced effect in the higher-risk groups, with the exception of cardiogenic shock where the effect was neutral.…”

“…[17][18][19][20] The main advantages of VCDs are greater patient comfort and improved cost-effectiveness because of reduced puncture site hemostasis time, bed rest, time to ambulation, and hospital stay compared with manual compression. [17][18][19][20][21][22] Although evidence has accrued that VCDs (compared with manual compression) may be of greater value in higher-risk subjects-such as those receiving anticoagulant agents-in terms of reducing bleeding complications, [23][24][25][26][27][28][29] with 1 population-based study (US CathPCI registry, n=1 819 611) 29 associating the most frequently used VCDs with a substantial reduction in bleeding and vascular complications, this has proven to be controversial, particularly because VCDs in themselves have been associated with life-threatening complications. 21,[30][31][32][33][34][35][36] Consequently, the 2010 American Heart Association guidelines give a class IIa recommendation for VCD (reasonable to perform the procedure) to achieve faster hemostasis and improve patient comfort and a class III recommendation (procedure should not be performed because it is not helpful and may be harmful) when used with the intent to reduce vascular complications.…”

“…21,[30][31][32][33][34][35][36] Consequently, the 2010 American Heart Association guidelines give a class IIa recommendation for VCD (reasonable to perform the procedure) to achieve faster hemostasis and improve patient comfort and a class III recommendation (procedure should not be performed because it is not helpful and may be harmful) when used with the intent to reduce vascular complications. 37 Given the potential association of VCDs with a reduction in vascular-related complications, [23][24][25][26][27][28][29] it is hypothesized that the uniform use of VCD in femoral-based PCI may confer a potential short-term mortality benefit compared with manual pressure, particularly in higher-risk subjects such as those with acute coronary syndrome or receiving more potent anticoagulant therapy. The purpose of this study was to assess the short-term (30-day) mortality of patients undergoing femoral-based PCI treated with VCDs compared with manual compression in a national, all-comers PCI registry for elective, non-ST-segment-elevation myocardial infarction and ST-segment-elevation myocardial infarction indications during a 5-year period in the United Kingdom.…”

Hemostatic Efficacy and Safety of a Novel Mechanical Compression Device for Femoral Arteriotomy

“…The patients were further divided into complication-free and complication groups (patients with either minor or major complications). The two groups were compared using the χ 2 …”