Document Detail


Vascular closure devices in patients treated with anticoagulation and IIb/IIIa receptor inhibitors during percutaneous revascularization.
MedLine Citation:
PMID:  12103259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The study assessed clinical outcomes of closure device use following percutaneous coronary revascularization using current standards of anticoagulation and antiplatelet therapy.
BACKGROUND: Evaluation of the outcomes of patients by use of vascular closure devices during coronary interventions employing current standards of anticoagulation and glycoprotein (GP) IIb/IIIa inhibitor therapy is limited.
METHODS: We evaluated outcomes of 4,525 consecutive patients who underwent percutaneous coronary intervention between July 1997 and April 2000. All patients received anticoagulation with heparin and GP IIb/IIIa inhibitor therapy with abciximab. The closure method was manual in 1,824 patients, Angioseal in 524 patients and Perclose in 2,177 patients. Procedural and hospital vascular outcomes were evaluated.
RESULTS: Closure device success was 97.1% Angioseal and 94.1% Perclose (p < 0.05). Minor vascular complications occurred in 1.8% of manual patients, 1.1% of Angioseal patients and 1.2% of Perclose patients (p = NS); major complications occurred in 1.3% of manual patients, 1.1% of Angioseal patients and 1.0% of Perclose patients (p = NS). Multivariate logistic regression identified only closure device failure as an independent predictor of a vascular complication. In patients with successful closure with a device, minor complications (0.8% vs. 1.8%, p < 0.05) and any complication (1.5% vs. 2.5%, p < 0.05) were reduced compared to manual compression.
CONCLUSIONS: Arterial closure following coronary interventions using anticoagulation and GP IIb/IIIa inhibitor therapy can be safely and effectively performed, with vascular complication rates similar to or lower than with manual pressure. Additionally, vascular complication rates using GP IIb/IIIa inhibitor therapy regardless of the method of arterial closure are equivalent to or lower than previously published rates of vascular complications.
Authors:
Robert J Applegate; Mark A Grabarczyk; William C Little; Timothy Craven; Michael Walkup; Frederic R Kahl; Gregory A Braden; Kevin M Rankin; Michael A Kutcher
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-09     Completed Date:  2002-07-26     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  78-83     Citation Subset:  AIM; IM    
Affiliation:
Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA. bapplega@wfubmc.edu
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MeSH Terms
Descriptor/Qualifier:
Antibodies, Monoclonal / therapeutic use*
Anticoagulants / therapeutic use*
Female
Hemostatic Techniques / instrumentation*
Heparin / therapeutic use*
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Logistic Models
Male
Middle Aged
Myocardial Revascularization*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Anticoagulants; 0/Immunoglobulin Fab Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 9005-49-6/Heparin; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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