Document Detail

Sheath pulling immediately after PTCA: comparison of two different deployment techniques for the hemostatic puncture closure device: a prospective, randomized study.
MedLine Citation:
PMID:  9258477     Owner:  NLM     Status:  MEDLINE    
Sheath pulling immediately after percutaneous transluminal coronary angioplasty (PTCA) increases patients' comfort, decreases burden for the medical staff, and may reduce hospital costs by shortening the length of stay. Immediate sheath pulling in anticoagulated patients with a low risk of bleeding complications is feasible using hemostatic devices. For the hemostatic puncture closing device (HPCD), published data regarding sheath pulling in patients immediately after PTCA is limited. Furthermore, no study addressed the question whether the recommended deployment time (DT) of 30 min can be reduced to a few minutes. We, therefore, performed a prospective study, randomizing 140 patients to a DT of 5 and 30 min, respectively. There were no statistical differences in gender, age, height, weight, or cardiovascular risk factors between the two groups. Blood pressures measured invasively immediately before sheath removal were comparable. Activated coagulation time just prior to sheath removal was 227 +/- 52 sec in the DT-5 group and 223 +/- 37 sec in the DT-30 group. After deployment, 74% of the DT-5 patients and 71% of the DT-30 patients showed immediate and complete hemostasis. The remaining patients showed only little oozing with complete hemostasis at the time of the final device removal. Hematoma size after 24 hr was 6.2 +/- 4.4 cm2 for DT-5 and 6.8 +/- 8.2 cm2 for DT-30 patients. There was no statistical difference between both groups. No severe bleeding or major complications were observed in either group. Thus, the use of a collagen system with an intra-arterial anchor (HPCD) is effective and safe when sheaths are pulled immediately after PTCA. The reduction of deployment time from 30 to 5 min is not related to an increased risk of bleeding or other vascular complications; patients can be transferred much faster to the ward, therefore reducing the burden on the personnel in the catheterization laboratory and increasing patients' comfort by allowing them to return to their rooms without a sheath.
S Silber; R Dörr; H Mühling; U König
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Catheterization and cardiovascular diagnosis     Volume:  41     ISSN:  0098-6569     ISO Abbreviation:  Cathet Cardiovasc Diagn     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-10-01     Completed Date:  1997-10-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7508512     Medline TA:  Cathet Cardiovasc Diagn     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  378-83     Citation Subset:  IM    
Dr. Müller Hospital, Munich, Germany.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Hemorrhage / etiology,  physiopathology
Hemostasis, Surgical / adverse effects,  instrumentation*,  methods*
Middle Aged
Postoperative Care / methods*
Prospective Studies
Treatment Outcome
Comment In:
Cathet Cardiovasc Diagn. 1997 Aug;41(4):384-5   [PMID:  9258478 ]

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