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Updated: Oct 26, 2025
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Published on: August 8, 2025
Is It Safe to Mobilize Patients Very Early After Transfemoral Coronary Procedures? (SAMOVAR): A Randomized Clinical
Insights
Immediate mobilization after transfemoral procedures like coronary angiography is safe and improves patient comfort. Patients experienced less back pain and fewer micturition issues without increased major bleeding complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Transfemoral access for coronary angiography (CAG) and percutaneous coronary intervention (PCI) often utilizes closure devices for hemostasis.
- The safety and patient comfort associated with immediate mobilization following these procedures remain areas of investigation.
Purpose of the Study:
- To compare bleeding complications between immediate mobilization and 2-hour bed rest after transfemoral CAG/PCI.
- To assess patient comfort levels in relation to mobilization versus bed rest protocols.
Main Methods:
- The SAMOVAR trial randomized patients undergoing transfemoral CAG/PCI with AngioSeal closure and heparin reversal to immediate mobilization (IM) or 2-hour bed rest (BR).
- Primary endpoint: hematoma >5 cm, pseudoaneurysm, or transfusion-requiring bleeding.
- Secondary endpoints: oozing, small hematoma, and patient comfort.
Main Results:
- No significant difference in primary outcomes between IM and BR groups (0.7% vs 0.5%, P=.58).
- Slightly increased oozing in the IM group (12% vs 9%, P=.04), but no difference in small hematomas.
- Patients in the IM group reported significantly less back pain and fewer micturition problems (P<.001).
Conclusions:
- Immediate mobilization following transfemoral CAG/PCI is safe when anticoagulation is reversed and closure devices are used.
- This approach is associated with low complication rates and enhanced patient comfort, including reduced pain and voiding difficulties.
Background:
Coronary angiography (CAG) and percutaneous coronary intervention (PCI) are performed via the femoral or radial arteries. In patients examined via transfemoral access, closure devices facilitate hemostasis, but it is unknown whether it is safe to mobilize these patients immediately and how acceptable this may be in terms of patient comfort.
Objective:
The aims of this study were to investigate bleeding complications in patients mobilized immediately after transfemoral CAG or PCI compared with patients on bed rest (BR) for 2 hours after the procedure and, furthermore, to investigate patient comfort in relation to mobilization and BR.
Methods:
SAMOVAR was a noninferiority trial with patients randomized to immediate mobilization (IM) or 2 hours of BR after transfemoral CAG or PCI and use of the AngioSeal as a closure device and reversal of heparin effect. The primary end point was development of hematoma greater than 5 cm, pseudoaneurysm, or bleeding requiring blood transfusion. Secondary end points were oozing from the puncture site, small hematoma, and patient comfort.
Results:
Of 2027 patients (IM, 1010; BR, 1017), 40% underwent PCI. The primary outcome was recorded in 0.7% patients randomized to IM versus 0.5% in BR ( P = .58). There was no difference in the incidence of small hematoma, whereas persistent oozing was seen slightly more often after IM compared with BR (12% vs 9%, P = .04). Patients mobilized immediately reported less back pain and micturition problems ( P < .001).
Conclusions:
In patients who had CAG and PCI performed through transfemoral access, reversal of anticoagulation and use of closure devices allowed IM with low rates of complications and improved patient comfort.
