ANN ARBOR, Mich. – Devices designed to prevent bleeding following certain cardiac procedures generally reduced blood transfusions and shortened bed rest for heart patients, according to an article published in Annals of Internal Medicine.
A team led by Hitinder S. Gurm, M.D., an interventional cardiologist at the University of Michigan Frankel Cardiovascular Center, analyzed data from 85,048 transfemoral percutaneous coronary intervention (PCI) procedures performed at 32 centers participating in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium.
They found that vascular closure devices (VCDs) were associated with a significant reduction in the odds of vascular complications, especially among overweight patients who are a majority of those undergoing the procedures to open blocked arteries.
The benefit was lost on lean or normal weight patients and those who received a platelet GP IIb/IIIa inhibitor. In those patients, there was no benefit to using VCDs. These findings should help guide physicians and patients in choosing between manual closure and VCDs in transfemoral PCI.
PCI, commonly called angioplasty, is a cardiac catheterization procedure in which a balloon catheter is inserted into the artery to unblock it. Vascular closure devices permit closure of the access site using sutures, plugs, or metallic clips.
The devices were developed as an alternative to manual compression which requires close observation and patient immobilization to be successful. VCDs are commonly used in clinical practice, yet there is little data on their usefulness for decreasing vascular complications.
“Closure devices reduced complications, but were not safer for all patients,” Gurm says. “I think our findings will help physicians decide when devices are preferable, in which patients they should be avoided and in which patient subgroups they could use either methods – manual closure or closure device.”
Funding: Blue Cross Blue Shield of Michigan and the National Science Foundation