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Published on: June 12, 2021
Vascular closure devices in acute coronary syndromes: from arbitrary to a necessity?
Jamil B Dihu1, Amar R Chadaga, Timothy A Sanborn
1Department of Medicine, Division of Cardiology, Northshore University Healthsystem, University of Chicago Pritzker School of Medicine, Evanston, IL 60201, USA.
Insights
Vascular closure devices (VCDs) may reduce bleeding complications in patients with acute coronary syndromes (ACS). This review analyzes data showing VCDs potentially lower bleeding and vascular issues in ACS patients undergoing percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access Management
Background:
- Vascular closure devices (VCDs) were designed to improve hemostasis after catheterization procedures.
- Conflicting data exists on VCDs' effectiveness in reducing access site bleeding across various clinical settings.
- Acute coronary syndromes (ACS) patients often receive multiple antiplatelet agents, increasing bleeding risk.
Purpose of the Study:
- To review the historical use of VCDs.
- To analyze data on access site bleeding in ACS patients.
- To assess the potential of VCDs in reducing bleeding and vascular complications in ACS.
Main Methods:
- Review of selected clinical trials on VCD use.
- Analysis of data concerning access site bleeding in ACS.
- Evaluation of VCD impact on bleeding and vascular complications in ACS patients undergoing PCI.
Main Results:
- Recent studies suggest VCDs reduce access site bleeding in ACS.
- VCDs may offer reductions in bleeding and vascular complications for ACS patients.
- Bleeding in ACS is a significant predictor of mortality.
Conclusions:
- VCDs show potential for reducing bleeding and vascular complications in ACS patients undergoing PCI.
- Further analysis supports the use of VCDs in high-risk ACS populations.
- Optimizing vascular access management is crucial in ACS care.
Abstract:
Vascular closure devices (VCDs) were initially developed to improve access site hemostasis and allow for earlier ambulation in patients undergoing diagnostic catheterization and percutaneous coronary intervention (PCI). Though initially thought to be beneficial, large meta-analysis has shown conflicting data regarding whether VCDs alter access site bleeding in a variety of clinical settings. One area of particular interest for the adoption of VCDs has been in the setting of acute coronary syndromes (ACS) in which multiple antiplatelet strategies are often employed leading to a high risk of bleeding. Bleeding in ACS has been shown to be a powerful independent predictor of 30-day mortality. Recently, investigators have reported that VCDs reduce access site bleeding in the setting of ACS. In our review, we use several selected representative clinical trials to provide a historical account for the use of VCDs. We also provide for a review of data as it relates to access site bleeding in ACS along with analysis showing that VCDs may potentially provide for reductions in bleeding and vascular complications in patients with ACS undergoing PCI.
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