RAPID ARTERIAL HEMOSTASIS AND DECREASED ACCESS SITE COMPLICATIONS AFTER CARDIAC-CATHETERIZATION AND ANGIOPLASTY - RESULTS OF A RANDOMIZED TRIAL OF A NOVEL HEMOSTATIC DEVICE

被引:198
作者
KUSSMAUL, WG
BUCHBINDER, M
WHITLOW, PL
AKER, UT
HEUSER, RR
KING, SB
KENT, KM
LEON, MB
KOLANSKY, DM
SANDZA, JG
机构
[1] PENN HOSP, PHILADELPHIA, PA 19107 USA
[2] UNIV CALIF SAN DIEGO, SAN DIEGO, CA 92103 USA
[3] CLEVELAND CLIN, CLEVELAND, OH 44106 USA
[4] MISSOURI BAPTIST MED CTR, ST LOUIS, MO USA
[5] ARIZONA HEART INST, PHOENIX, AZ USA
[6] EMORY UNIV, ATLANTA, GA 30322 USA
[7] WASHINGTON CARDIOL CTR, WASHINGTON, DC USA
[8] UNIV PENN, PHILADELPHIA, PA 19104 USA
关键词
D O I
10.1016/0735-1097(95)00101-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. This study was performed to test the safety and efficacy of a novel bioabsorbable hemostatic puncture closure device deployed through an arterial sheath. Background. Cardiac catheterization procedures are associated with a risk of complications at the arterial access site. Increasing numbers of interventional procedures requiring large sheaths or intense anticoagulation underline the need for secure, rapid methods of obtaining hemostasis at the time of sheath removal. Methods. We conducted a randomized, multicenter trial in 435 patients undergoing cardiac catheterization or angioplasty at eight participating centers. In 218 patients, hemostasis was achieved using the device (group I); 217 patients were assigned to the manual pressure control group (group II). Results. There were no significant differences in baseline characteristics. Time to hemostasis was considerably shorter in group I (2.5 +/- 15.2 vs. 15.3 +/- 11.7 min [mean +/- SD], p < 0.0001). The deployment success rate for the device was 96%, and 76% of group I patients experienced immediate (within 1 min) hemostasis. Complication rates were lower in group I for bleeding, hematoma and occurrence of any complication. There was no difference in the small incidence of pseudoaneurysm formation. There was no change in either group in the ankle/brachial systolic blood pressure index. Ultrasound follow-up studies 60 days after device deployment revealed complete absorption of the device in all cases. Subgroup analysis revealed particular benefit in patients undergoing interventional procedures. The administration of heparin was associated with a significantly higher complication rate in the manual pressure control group, whereas heparin had no effect on hemostasis time or complication rates in the device group. Conclusions. This sheath-deployed, bioabsorbable device provides a safe and effective means of obtaining rapid arterial hemostasis after cardiac catheterization procedures. It appears to be particularly useful in those patients most at risk for access site complications.
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收藏
页码:1685 / 1692
页数:8
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