Bleeding and vascular complications at the femoral access site following percutaneous coronary intervention (PCI): an evaluation of hemostasis strategies.
BACKGROUND
Previous research found at least one vascular closure device (VCD) to be associated with excess vascular complications, compared to manual compression (MC) controls, following cardiac catheterization. Since that time, several more VCDs have been approved by the Food and Drug Administration (FDA). This research evaluates the safety profiles of current frequently used VCDs and other hemostasis strategies.


METHODS
Of 1089 sites that submitted data to the CathPCI Registry from 2005 through the second quarter of 2009, a total of 1,819,611 percutaneous coronary intervention (PCI) procedures performed via femoral access site were analyzed. Assessed outcomes included bleeding, femoral artery occlusion, embolization, artery dissection, pseudoaneurysm, and arteriovenous fistula. Seven types of hemostasis strategy were evaluated for rate of "any bleeding or vascular complication" compared to MC controls, using hierarchical multiple logistic regression analysis, controlling for demographic factors, type of hemostasis, several indices of co-morbidity, and other potential confounding variables. Rates for different types of hemostasis strategy were plotted over time, using linear regression analysis.


RESULTS
Four of the VCDs and hemostasis patches demonstrated significantly lower bleeding or vascular complication rates than MC controls: Angio-Seal (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.65-0.70); Perclose (OR, 0.54; CI, 0.51-0.57); StarClose (OR, 0.77; CI, 0.72-0.82); Boomerang Closure Wire (OR, 0.63; CI, 0.53-0.75); and hemostasis patches (OR, 0.70; CI, 0.67-0.74). All types of hemostasis strategy, including MC, exhibited reduced complication rates over time. All trends were statistically significant except one.


CONCLUSIONS
This large, nationally representative observational study demonstrated better safety profiles for most of the frequently used VCDs, compared to MC controls.
US Food and Drug Administration (FDA), Silver Spring, MD, USA. dale.tavris@fda.hhs.gov
Dale R
DR
Tavris
Yongfei
Y
Wang
Samantha
S
Jacobs
Beverly
B
Gallauresi
Jeptha
J
Curtis
John
J
Messenger
Frederic S
FS
Resnic
Susan
S
Fitzgerald
D017541:Aneurysm, False / Q000453:epidemiology / Q000628:therapy*; D004617:Embolism / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000293:injuries*; D006470:Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011312:Pressure; D012042:Registries; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation*