Closure Devices in PCI Reduce Complications, Transfusions

November 14, 2013

ANN ARBOR, MI — The use of vascular-closure devices in patients undergoing transfemoral PCI is associated with a significant reduction in vascular complications and the need for blood transfusions, according to a large statewide analysis[1].

Among more than 85 000 PCIs performed across 32 hospitals in Michigan, the use of a vascular-closure device, which was used in 37% of cases, reduced the risk of vascular complications by 22% and the need for postprocedural blood transfusions by 15% compared with the use of manual closure.

Regarding the specific subtypes of vascular complications, the closure devices were associated with a 31% lower risk of hematomas and a 46% lower risk of pseudoaneurysms.

Reporting their results online November 11, 2013 in the Annals of Internal Medicine, Dr Hitinder Gurm (University of Michigan, Ann Arbor) and colleagues say the findings are important because vascular-closure devices are better tolerated and allow patients to get mobile faster than manual closure. Moreover, the benefit of the vascular-closure devices was observed in overweight or obese patients only, a group of patients in whom control of the access site is often difficult. There was no benefit in individuals with a lean or normal body-mass index, they point out.

In addition, the reduction in vascular complications and the need for blood transfusions was not observed in patients who also received GP IIb/IIIa inhibitors.

In the 28 528 patients who received the vascular-closure devices, the risk of retroperitoneal bleeding was approximately 50% higher than in those undergoing manual closure. The researchers point out that retroperitoneal bleeding is a "serious complication" and is strongly associated with death.

"Our data suggest that physicians contemplating vascular-closure device use should carefully weigh this increased risk for retroperitoneal bleeding against the expected reduction in pseudoaneurysms and hematomas," write Gurm and colleagues. "The decision to use these devices needs to be individualized for each patient."

Financial support for the study was provided by the Blue Cross Blue Shield. Gurm reports grants from National Institutes of Health, the Agency for Healthcare Research and Quality, Blue Cross Blue Shield of Michigan, and Osprey Medical. Disclosures for the coauthors are listed on the journal's website.

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