Immediate femoral sheath removal after 6 French routine coronary angioplasty with a weight-adjusted low-dose heparin: results of a prospective registry.
This study assesses the feasibility and safety of immediate sheath removal after coronary angioplasty with the use of 6 French (Fr) guiding catheters by the femoral route and weight-adjusted low-dose heparin (100 IU/kg). We prospectively evaluated such a strategy among a single-center cohort of 261 consecutive patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA). Immediate sheath withdrawal was performed in cases when post-PTCA residual coronary stenosis was less than 30%, with or without stenting. One hundred eighty-two (70%) of the enrolled patients were eligible for immediate sheath removal. When compared with non-eligible patients (sheath removal 4 hours or more post-PTCA), we observed a reduction of hematoma occurrence (15% vs. 30%; p < 0.01), time to manual hemostasis of the puncture site (13.8 +/- 7 vs. 19.7 +/- 12 minutes; p < 0.0001), and time to hospital discharge (2.2 +/- 1.9 vs. 2.8 +/- 1.8 days; p < 0.02), while ischemic event rate was similar (1 vs. 2 non-Q wave myocardial infarction; 2 vs. 1 repeat PTCA for out-of-lab acute vessel closure). In conclusion, a good angiographic result at completion of PTCA using a 6 Fr sheath, even without stenting, makes an immediate sheath removal feasible at no increased risk and with a potential reduction in minor bleeding complications.
Metz
D
D
Cardiology Department, Hopital Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex, France. dmetz@chu-reims.fr
Brasselet
C
C
Tabet
E
E
Nazeyrollas
P
P
Tassan-Mangina
S
S
Deschildre
A
A
Elaerts
J
J
Blaise
C
C
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001835:Body Weight; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003327:Coronary Disease / Q000628:therapy; D020878:Device Removal; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors
D006493:Heparin