Percutaneous coronary intervention with bivalirudin anticoagulation, immediate sheath removal, and early ambulation: a feasibility study with implications for day-stay procedures.
We assessed the feasibility and safety of a strategy of transfemoral percutaneous coronary intervention (PCI) with bivalirudin anticoagulation, immediate sheath removal, early ambulation, and, where possible, same-day discharge in 100 consecutive patients. Ambulation was achieved by 2 hr 30 min in 85% of patients and same-day discharge in 26%. PCI was angiographically successful in 97%. In hospital, there were no deaths or Q-wave myocardial infarctions. One patient suffered a non-Q-wave infarction, another in-hospital surgical revascularization and one required blood transfusion for rectal bleeding. Femoral access site hematoma > 5 cm diameter occurred in two patients. In addition, by 1 month there had been one death (at 10 days) and one pseudoaneurysm treated nonsurgically. In this preliminary study, the strategy of bivalirudin bolus anticoagulation, immediate sheath removal, and 2-hr ambulation after PCI appeared safe, with same-day discharge possible in 26% of unselected patients with stable or unstable angina.
Ormiston
John A
JA
Mercy Angiography, Auckland, New Zealand. johno@mercyangiography.co.nz
Shaw
Bronwyn L
BL
Panther
Monique J
MJ
Ruygrok
Peter N
PN
Devlin
Gerard P
GP
Stewart
Ralph A H
RA
Webster
Mark W I
MW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D000787:Angina Pectoris / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000925:Anticoagulants / Q000008:administration & dosage*; D000991:Antithrombins / Q000008:administration & dosage*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery; D006629:Hirudins / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000008:administration & dosage*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin