Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices

Abid R. Assali, Stefano Sdringola, Ali Moustapha, Mohammad Ghani, Joseph Salloum, George Schroth, Kenichi Fujise, H. Vernon Anderson, Richard W. Smalling, Oscar R. Rosales

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

The most consistent procedural predictor of vascular access site complications thus far has been the intensity and duration of anticoagulant therapy during and after percutaneous coronary interventions (PCI). Several devices have been developed to aid in the closure of the femoral arteriotomy. This report describes the clinical outcome of unsuccessful deployment of femoral closure devices in a cohort of 285 consecutive patients who underwent PCI and were treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. Manual femoral artery compression was used in 123 patients, Perclose in 123 patients, and AngioSeal in 39 patients. Successful homeostasis was achieved in 98.4% of patients who received manual compression, in 91.9% of the Perclose-sealed arteriotomy, and in 84.6% of patients who received the AngioSeal closure device (P = 0.004). The incidence of vascular complications after successful deployment was 9%. Patients not achieving hemostasis with closure device or 1° manual compression developed complications in the majority of cases (> 80%; P < 0.05). By multivariate analysis (with adjustment for baseline differences), the use of AngioSeal closure device was found to be an independent risk factors leading to primary deployment failure and all access site complications (OR 2.97; 95% Cl 1.5-6.0; P = 0.006). In summary, failed hemostasis by artery closure devices in patients undergoing PCI who are treated with GP IIb/IIIa inhibitors is associated with significant vascular complications. AngioSeal may be associated with a higher failure rate, while manual compression and Perclose seem to be more effective with a lower complication rate.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume58
Issue number1
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

Fingerprint

Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Equipment and Supplies
Percutaneous Coronary Intervention
Blood Vessels
Thigh
Hemostasis
Femoral Artery
Anticoagulants
Homeostasis
Multivariate Analysis
Arteries
Incidence

Keywords

  • Femoral closure device
  • GP IIb/IIIa inhibitors
  • Vascular access complication

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices. / Assali, Abid R.; Sdringola, Stefano; Moustapha, Ali; Ghani, Mohammad; Salloum, Joseph; Schroth, George; Fujise, Kenichi; Anderson, H. Vernon; Smalling, Richard W.; Rosales, Oscar R.

In: Catheterization and Cardiovascular Interventions, Vol. 58, No. 1, 01.01.2003, p. 1-5.

Research output: Contribution to journalArticle

Assali, AR, Sdringola, S, Moustapha, A, Ghani, M, Salloum, J, Schroth, G, Fujise, K, Anderson, HV, Smalling, RW & Rosales, OR 2003, 'Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices', Catheterization and Cardiovascular Interventions, vol. 58, no. 1, pp. 1-5. https://doi.org/10.1002/ccd.10384
Assali, Abid R. ; Sdringola, Stefano ; Moustapha, Ali ; Ghani, Mohammad ; Salloum, Joseph ; Schroth, George ; Fujise, Kenichi ; Anderson, H. Vernon ; Smalling, Richard W. ; Rosales, Oscar R. / Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices. In: Catheterization and Cardiovascular Interventions. 2003 ; Vol. 58, No. 1. pp. 1-5.
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abstract = "The most consistent procedural predictor of vascular access site complications thus far has been the intensity and duration of anticoagulant therapy during and after percutaneous coronary interventions (PCI). Several devices have been developed to aid in the closure of the femoral arteriotomy. This report describes the clinical outcome of unsuccessful deployment of femoral closure devices in a cohort of 285 consecutive patients who underwent PCI and were treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. Manual femoral artery compression was used in 123 patients, Perclose in 123 patients, and AngioSeal in 39 patients. Successful homeostasis was achieved in 98.4{\%} of patients who received manual compression, in 91.9{\%} of the Perclose-sealed arteriotomy, and in 84.6{\%} of patients who received the AngioSeal closure device (P = 0.004). The incidence of vascular complications after successful deployment was 9{\%}. Patients not achieving hemostasis with closure device or 1° manual compression developed complications in the majority of cases (> 80{\%}; P < 0.05). By multivariate analysis (with adjustment for baseline differences), the use of AngioSeal closure device was found to be an independent risk factors leading to primary deployment failure and all access site complications (OR 2.97; 95{\%} Cl 1.5-6.0; P = 0.006). In summary, failed hemostasis by artery closure devices in patients undergoing PCI who are treated with GP IIb/IIIa inhibitors is associated with significant vascular complications. AngioSeal may be associated with a higher failure rate, while manual compression and Perclose seem to be more effective with a lower complication rate.",
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