P3613Vascular access devices (VADs), vascular closure devices (VCDs) and hemorrhagic complications - real-life study in our hospital

Abstract

Introduction: VADs were developed to achieve hemostasis, as well as reduce access site complications, reduce time to ambulation and the time to hospital discharge, and more comfortable for the patient compared to manual compression, after a cardiovascular procedure requiring a catheterization. Purpose: This study was to evaluate and compare between the different methods and devices that we have in our hospital. Methods: We performed a prospective analysis with consecutive inclusion of 760 patients who were admitted with acute coronary syndrome and underwent percutaneous coronary intervention (PCI) with femoral approach and an VCD. The inclusion period was from 10/2009 to 09/2016. We classified these patients into 4 groups: A) Femoseal (n=168, 68.6% male); B) Exoseal (n=422, 74.4% male); C) Angioseal (n=116, 75% male); D) failure of VCDs that have required manual compression (n=53, 56.6% male).We have done a comparison between groups about the primary composite endpoint (PCE) (death, stroke and myocardial reinfarction) and each variable. Then, we perform a sub-analysis to compared trans-radial and trans-femoral artery access who underwent PCI. Results: There were no statistical difference between age, cardiovascular risk factors, diabetes, dyslipidemia and smoking. There were also no statistical difference having or not chronic kidney disease (p=0.768) or peripheral artery disease (p=0.73). The medication prescribed were similar, no difference in antiplatelet agents (single/dual antiplatelet therapy, p=0.314) or anticoagulation (A=2.4%, B=2.4%, C=4.3%, D=3.8%, p=0.665). There was no difference in the vascular devices independently of the diagnostic (STEMI: A=51.5%, B=54%, C=56%, D=66%, NSTEMI/AI: A= 48.5%, B=46%, C=44%, D=34%, p=0.306). Clopidogrel were less administered compared with ticagrelor or prasugrel in A (p<0.001). The use of Angioseal and Exoseal were higher with the administration of fondaparinux (p<0.001) and glycoprotein IIb/IIIa inhibitors (p<0.001), instead of unfractionated heparin or low molecular weight heparins were more administered in those who use Femoseal (p=0.003). Use of inotropes was higher when it have had failure of VCDs requiring manual compression (A=13.6%, B=6.4%, C=3.4%, D=34%, p<0.001), with severe bleeding and cardiogenic shock in that group (A=11.8%, B=6.4%, C=1.7%, D=32.1%, p<0.001). It was related with higher cardiopulmonary resuscitation (A=4.7%, B= 6.2%, C=1.7%, D=18.9%, p<0.001) and hospital mortality (A=6.5%, B=3.3%, C=1.7%, D=17%, p<0.001), having prescribed antiplatelet agents or beta-blockers at discharge. The PCE was higher in D (D= 22.6%, p<0.001). Conclusions: The use of different devices was accompanied with changes in the scientific world that had changed our clinical practice. The failure of device requiring manual compressive identified a group of patients more complex and with poor prognosis.