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Vascular closure devices in patients treated with anticoagulation and IIb/IIIa receptor inhibitors during
Robert J Applegate1, Mark A Grabarczyk, William C Little
1Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA. bapplega@wfubmc.edu
Insights
Vascular closure devices are safe and effective after percutaneous coronary interventions with current anticoagulation and antiplatelet therapy. Device closure resulted in fewer complications compared to manual compression.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Limited data exist on vascular closure device outcomes in coronary interventions with modern anticoagulation and glycoprotein (GP) IIb/IIIa inhibitor therapy.
- Current standards involve heparin and GP IIb/IIIa inhibitors like abciximab.
Purpose of the Study:
- To assess clinical outcomes of vascular closure device use after percutaneous coronary revascularization.
- To compare outcomes between manual closure, Angioseal, and Perclose devices.
Main Methods:
- A retrospective evaluation of 4,525 patients undergoing percutaneous coronary intervention between July 1997 and April 2000.
- Patients received heparin and abciximab; closure methods included manual compression, Angioseal, and Perclose.
- Procedural and hospital vascular outcomes were analyzed.
Main Results:
- Closure device success rates were 97.1% for Angioseal and 94.1% for Perclose (p < 0.05).
- Minor and major vascular complication rates were similar between manual and device closure groups (p = NS).
- Successful device closure significantly reduced minor (0.8% vs. 1.8%) and any complications (1.5% vs. 2.5%) compared to manual compression (p < 0.05).
Conclusions:
- Arterial closure after coronary interventions with anticoagulation and GP IIb/IIIa inhibitors is safe and effective.
- Vascular complication rates with closure devices are comparable to or lower than manual pressure.
- Rates are similar to or lower than previously published data, even with GP IIb/IIIa inhibitor use.
Objectives:
The study assessed clinical outcomes of closure device use following percutaneous coronary revascularization using current standards of anticoagulation and antiplatelet therapy.
Background:
Evaluation of the outcomes of patients by use of vascular closure devices during coronary interventions employing current standards of anticoagulation and glycoprotein (GP) IIb/IIIa inhibitor therapy is limited.
Methods:
We evaluated outcomes of 4,525 consecutive patients who underwent percutaneous coronary intervention between July 1997 and April 2000. All patients received anticoagulation with heparin and GP IIb/IIIa inhibitor therapy with abciximab. The closure method was manual in 1,824 patients, Angioseal in 524 patients and Perclose in 2,177 patients. Procedural and hospital vascular outcomes were evaluated.
Results:
Closure device success was 97.1% Angioseal and 94.1% Perclose (p < 0.05). Minor vascular complications occurred in 1.8% of manual patients, 1.1% of Angioseal patients and 1.2% of Perclose patients (p = NS); major complications occurred in 1.3% of manual patients, 1.1% of Angioseal patients and 1.0% of Perclose patients (p = NS). Multivariate logistic regression identified only closure device failure as an independent predictor of a vascular complication. In patients with successful closure with a device, minor complications (0.8% vs. 1.8%, p < 0.05) and any complication (1.5% vs. 2.5%, p < 0.05) were reduced compared to manual compression.
Conclusions:
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.
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