title: Utilisation of bivalirudin and vascular closure devices for same-day discharge after percutaneous coronary and peripheral interventions.
abstract: BACKGROUND
  Currently the majority of coronary and peripheral interventions are performed with an overnight stay. This increases the cost and does not reduce logistic constraints on hospital resources. We hypothesised that by combining bivalirudin with vascular closure devices we can safely discharge patients on the same day after percutaneous coronary intervention (PCI) and percutaneous transluminal angioplasty (PTA) without increasing their risk of bleeding.
  
  
  OBJECTIVE
  To evaluate the safety and the feasibility of same-day discharge after PCI and PTA using bivalirudin and vascular closure devices.
  
  
  METHODS
  This is a retrospective analysis of 833 consecutive patients who underwent percutaneous procedures in our centre between January 2007 and February 2010. The population was divided into interventional and diagnostic arms. All interventions were done with use of bivalirudin for anticoagulation and vascular closure devices for achieving haemostasis. Haemostasis in the diagnostic cohort was achieved with standard manual compression. The mean time of observation was 30 days. The mean age of patients was 64.3 years. The primary endpoint was any bleeding event meeting GUSTO criteria. The secondary endpoints included local vascular complications, major adverse cardiac and cerebrovascular events, time to ambulation and discharge, as well as need for overnight hospitalisation.
  
  
  RESULTS
  In 30-day observation the primary endpoint occurred in 4.0% of patients in the interventional group and in 2.6% of patients in the diagnostic group (p = 0.31). The frequency of local vascular complications was higher in the interventional group although it was not statistically significant (3.1% vs. 2.9%; p = 0.33). Patients from the interventional group were ambulated sooner compared to the diagnostic group (117.5 vs. 131 min; p = 0.003). Time to discharge was 316.4 ± 38.7 min and 214.2 ± 23.4 min for interventional and diagnostic procedures, respectively (p < 0.001).
  
  
  CONCLUSIONS
  PCI and PTA in the selected group of patients, with use of bivalirudin and vascular closure devices, do not appear to have increased risk of post-procedural events when compared to diagnostic procedures, and can be done safely without the need for an overnight stay.
authors.affiliation: San Antonio Endovascular and Heart Institute, San Antonio, TX, United States 3rd Department of Interventional Cardiology and Electrophysiology, American Heart of Poland, Dabrowa Gornicza, Poland. szymrad83@gmail.com.
authors.forename: Radosław J
authors.initials: RJ
authors.lastname: Szymański
authors.forename: Radosław S
authors.initials: RS
authors.lastname: Kiesz
authors.forename: Szymon Ł
authors.initials: SŁ
authors.lastname: Wiernek
authors.forename: Barbara
authors.initials: B
authors.lastname: Wiernek
authors.forename: Damian
authors.initials: D
authors.lastname: Kawecki
authors.forename: Marcin
authors.initials: M
authors.lastname: Dębiński
authors.forename: Marek
authors.initials: M
authors.lastname: Kondys
authors.forename: Radosław
authors.initials: R
authors.lastname: Olszewski
authors.forename: Jacek
authors.initials: J
authors.lastname: Szyguła
authors.forename: Paweł E
authors.initials: PE
authors.lastname: Buszman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006629:Hirudins; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D065506:Vascular Closure Devices
chemical_list: D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin
keywords: bivalirudin; same day discharge; vascular closure devices