Three strategies for hemostasis at femoral artery access site: A comparison of safety and efficacy / 第二军医大学学报

ABSTRACT

Objective: To assess the safety and efficacy of the standard manual compression and 2 arterial puncture closing devices, Angioseal and Perclose, for hemostasis at the femoral artery access site in patients undergoing coronary angiography (CAG) or percutaneous coronary interventions (PCI). Methods: Totally 366 patients undergoing coronary angiography or PCI were assigned to receive either Angioseal (n=128), Perclose (n=110) or standard manual compression (n=128). The efficacy endpoint (immediate hemostasis, successful hemostasis rate, operating time, time of leg immobilization and time to hemostasis) and safety endpoint (vasovagal reflex, major complications, local complications, hematocrit drop, etc.) were evaluated. Risk factors (gender, age, body mass index, comorbid conditions, antiplatelet agents, and anticoagulant agents, etc.) were also analyzed. Results: The successful hemostasis rates were similar be tween Angioseal group and Perclose group, but the rate of immediate hemostasis of Angioseal group was higher than that of Perclose group (P<0.01). Time of leg immobilization and time to hemostasis in Angioseal group and Perclose group was shorter than those of manual compression group(P<0.01). Both vasovagal reflex (9.3%) and major complications (3.1%) were only noticed in manual compression group. The rates of local complications in manual compression group and Angioseal group were both lower than that of Perclose group(P<0.01). Post-procedure unfractionated heparin was associated with increased risk of hematoma (OR=4.382, P<0.05), post-procedure clopidogrel (OR=3.549, P<0.01) and interventional procedures (OR=6.584, P<0.05) were associated with increased risk of blood oozing, and female gender was associated with a reduced risk of blood oozing (OR=0.132, P<0.05). The successful hemostasis rates were lower in the elderly and those receiving PCI. Post-procedure unfractionated heparin and low molecular weight heparin was associated with longer hemostasis time. Conclusion: Perclose and An gioseal can be an alternative of standard manual compression for hemostasis of the femoral artery access site. Angioseal may be better than Perclose regarding the immediate hemostasis and local complications.