Hemostasis in the Era of the Chronic Anticoagulated Patient
- Volume 15 - Issue 1 - January, 2004
- Posted on: 8/1/08
- 0 Comments
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Nader et al.7 reported their experience with 1,000 consecutive patients in the largest series of patients that has been reported to date with the use of assisted compression with pGlcNAc. There were 636 diagnostic procedures and 364 interventional procedures observed. Assisted compression was used for 10 minutes in the diagnostic group and for 20 minutes in the interventional group as long as the ACT was less than 300 seconds. Their endpoint was complication rates rather than compression times. In the interventional group, about 76% of patients had ACTs of 200 seconds or more. A significant number of patients were taking platelet inhibitors. The overall major complication rate was 0.1%, and the minor complication rate was 1.3%. These are observational cohorts. Divided by type of procedures, the major complication was a pseudoaneurysm, which occurred in the interventional group; there were no major complications in the diagnostic group. There were 4 minor complications in the interventional group (3 small hemotomas and one nuisance bleed) and 9 minor complications in the diagnostic group (4 small hemotomas, 5 nuisance bleeds), suggesting that assisted compression with the pGlcNAc patch has a benign complication profile based on this cohort of patients.
There is mounting clinical evidence that assisted or accelerated compression with pGlcNAc may be as effective as standard of care, if not superior, but there are no trials yet to prove this. Assisted compression is as effective as arterial closure devices; has low complication profiles; may decrease the sheath dwell times and compression times, which is an outcome that is important for patients; and enables early ambulation, which is important for catheterization laboratory staff.
Decreased sheath dwell time, decreased time to hemostasis or early ambulation are the most desirable outcomes when dealing with hemostasis. Assisted compression with pGlcNAc may help achieve these outcomes with the added benefit of lower complication rates and costs when compared with closure devices. The present data invites physicians to take pause when deciding the best and safest ways of achieving hemostasis and calls for additional studies of assisted compression.