Abstract 1964: Vascular Complications after Cath and Percutaneous Coronary Intervention: Thrombin Hemostatic Patch Versus Manual Compression
Background. Hemostatic patches shorten the time to hemostasis and ambulation after percutaneous cardiac procedures involving femoral artery access, but how their safety compares to manual compression remains uncertain.
Methods. We evaluated vascular complications in 7,835 patients (5,420 diagnostic catheterization (DxC) and 2,415 PCI) following use of manual compression (MC) in 4,371 consecutive patients, and a thrombin hemostatic bandage (THP) in 3,464 consecutive patients. Sheaths were pulled immediately after diagnostic catheterization, or when the ACT was ≤ 180s after PCI. Ambulation was begun 4 – 6 hours after MC or 2 hours after THP. Propensity analysis was used to correct for the minimal baseline differences.
Results. Minor vascular complications (hematoma > 10 mm, pseudoaneurysm, AV fistulae) occurred in 0.69% of MC patients, and 0.35% of THP patients, p = 0.041; major complications (bleeding, vessel occlusion, loss of pulse, or vascular repair) in 0.48% of MC patients, and 0.29% of THP patients, p = 0.18; and any vascular complication in 1.0% of MC patients, and 0.59% of THP patients, p = 0.036. After DxC any vascular complication occurred in 0.88% of MC patients, and 0.41% of THP patients, p < 0.05; and after PCI in 1.27% of MC patients, and 1.00% of THP patients, p = NS. Propensity score adjusted odds ratio of vascular complications, THP vs. MC, is shown in the table⇓.
Conclusion. Use of a thrombin hemostatic patch was associated with a lower incidence of vascular complications after diagnostic catheterization, primarily a decrease in hematoma > 10 cm. Thus, use of a thrombin hemostatic patch is as safe as manual compression after PCI, and safer for diagnostic catheterization.