Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal

Warren J. Cantor, Kenneth W. Mahaffey, Zhen Huang, Pranab Das, Dietrich C. Gulba, Stanislav Glezer, Richard Gallo, John Ducas, Marc Cohen, Elliott M. Antman, Anatoly Langer, Neal S. Kleiman, Harvey D. White, Robert J. Chisholm, Robert A. Harrington, James J. Ferguson, Robert M. Califf, Shaun G. Goodman

Research output: Contribution to journalArticle

105 Scopus citations

Abstract

Objectives: Our objective was to analyze the impact of arterial access site, sheath size, timing of sheath removal, and use of access site closure devices on high-risk patients with acute coronary syndromes (ACS). Background: In the SYNERGY trial, 9,978 patients with ACS were randomly assigned to receive enoxaparin or unfractionated heparin. Methods: This analysis includes 9,404 patients for whom sheath access information was obtained for the first PCI procedure or diagnostic catheterization. Comparisons of baseline, angiographic, and procedural characteristics were carried out according to access site and sheath size. Results: Overall, 9,404 (94%) patients underwent angiography at a median of 21 hr (25th and 75th percentiles: 5, 42) and 4,687 (50%) underwent PCI at a median of 23 hr (6,49) of enrollment. The access site was femoral for 94.9% of cases, radial for 4.4%, and brachial for 0.7%. Radial access was associated with fewer transfusions than femoral access (0.9% vs. 4.8%, P = 0.007). For femoral access, the rates of noncoronary artery bypass grafting (CABG)-related TIMI major bleeding by sheath size was 1.5% for 4 or 5 French (Fr), 1.6% for 6 Fr, 3.3% for 7 Fr, and 3.8% for ≥ 8 Fr (P < 0.0001). After adjustment for baseline characteristics, femoral access site, larger sheath size, and delayed sheath removal were independent predictors of need for transfusion. Conclusions: Smaller sheaths, radial access, and timely sheath removal may mitigate the bleeding risk associated with potent antithrombotic/ platelet therapy and early catheterization.

Original languageEnglish (US)
Pages (from-to)73-83
Number of pages11
JournalCatheterization and Cardiovascular Interventions
Volume69
Issue number1
DOIs
StatePublished - Jan 2007

Keywords

  • Blood loss
  • Coronary disease
  • Device removal
  • Radial artery
  • Surgical

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Fingerprint Dive into the research topics of 'Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal'. Together they form a unique fingerprint.

Cite this