Comparison of Access Site Complications after Early or Late Sheath Removal in Patients with PCI, Regardless of ACT Levels

Abstract

Background: Despite the lack of supporting data, many clinics perform sheath removal 4-6 hours after femoral percutaneous coronary intervention to reduce the risk of possible access site complications. This study aims to examine the effects of sheath removal immediately after the procedure on access site complications and patient comfort. Methods: This prospective study included 349 patients who underwent percutaneous coronary intervention via the femoral site and 6 French guiding catheters. The sheath in the early group was removed immediately after the procedure without checking the activated clotting time levels but after 4 hours in the late group. Access site complications were recorded and patient comfort was evaluated using the Visual Analog Scale. Results: Patients were divided into 2 groups: patients in the early removal group (n = 171) and in the late removal group (n = 178). There was no statistically significant difference between the 2 groups in terms of access site complications. Three patients in the early removal group and 4 patients in the late removal group developed a hematoma. Six patients in the early removal group and 10 patients in the late removal group showed ecchymosis. The Visual Analog Scale score was statistically significantly lower in the early removal group compared with that in the late removal group [2 (1-3) vs. 3 (2-4), P < .001]. Conclusion: This study shows that immediate sheath removal is safe and more comfortable for patients with percutaneous coronary intervention who received weight-adjusted dose of heparin, regardless of the percutaneous coronary intervention levels after the procedure.