经皮血管重建术中接受抗凝治疗及使用IIb/IIIa受体抑制剂治疗的患者的血管闭合装置

Vascular closure devices in patients treated with anticoagulation and IIb/IIIa receptor inhibitors during percutaneous revascularization.

作者信息

Applegate Robert J, Grabarczyk Mark A, Little William C, Craven Timothy, Walkup Michael, Kahl Frederic R, Braden Gregory A, Rankin Kevin M, Kutcher Michael A

机构信息

Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.

出版信息

J Am Coll Cardiol. 2002 Jul 3;40(1):78-83. doi: 10.1016/s0735-1097(02)01924-1.

DOI:10.1016/s0735-1097(02)01924-1

PMID:12103259

Abstract

OBJECTIVES

The study assessed clinical outcomes of closure device use following percutaneous coronary revascularization using current standards of anticoagulation and antiplatelet therapy.

BACKGROUND

Evaluation of the outcomes of patients by use of vascular closure devices during coronary interventions employing current standards of anticoagulation and glycoprotein (GP) IIb/IIIa inhibitor therapy is limited.

METHODS

We evaluated outcomes of 4,525 consecutive patients who underwent percutaneous coronary intervention between July 1997 and April 2000. All patients received anticoagulation with heparin and GP IIb/IIIa inhibitor therapy with abciximab. The closure method was manual in 1,824 patients, Angioseal in 524 patients and Perclose in 2,177 patients. Procedural and hospital vascular outcomes were evaluated.

RESULTS

Closure device success was 97.1% Angioseal and 94.1% Perclose (p < 0.05). Minor vascular complications occurred in 1.8% of manual patients, 1.1% of Angioseal patients and 1.2% of Perclose patients (p = NS); major complications occurred in 1.3% of manual patients, 1.1% of Angioseal patients and 1.0% of Perclose patients (p = NS). Multivariate logistic regression identified only closure device failure as an independent predictor of a vascular complication. In patients with successful closure with a device, minor complications (0.8% vs. 1.8%, p < 0.05) and any complication (1.5% vs. 2.5%, p < 0.05) were reduced compared to manual compression.

CONCLUSIONS

Arterial closure following coronary interventions using anticoagulation and GP IIb/IIIa inhibitor therapy can be safely and effectively performed, with vascular complication rates similar to or lower than with manual pressure. Additionally, vascular complication rates using GP IIb/IIIa inhibitor therapy regardless of the method of arterial closure are equivalent to or lower than previously published rates of vascular complications.

摘要

目的

本研究采用当前抗凝和抗血小板治疗标准，评估经皮冠状动脉血运重建术后使用闭合装置的临床结局。

背景

在采用当前抗凝和糖蛋白（GP）IIb/IIIa抑制剂治疗标准的冠状动脉介入治疗期间，使用血管闭合装置对患者结局进行评估的研究有限。

方法

我们评估了1997年7月至2000年4月期间连续接受经皮冠状动脉介入治疗的4525例患者的结局。所有患者均接受肝素抗凝及阿昔单抗GP IIb/IIIa抑制剂治疗。1824例患者采用手动压迫闭合，524例患者采用Angioseal闭合装置，2177例患者采用Perclose闭合装置。评估手术及住院期间的血管结局。

结果

Angioseal闭合装置成功率为97.1%，Perclose闭合装置成功率为94.1%（p<0.05）。手动压迫组患者发生轻微血管并发症的比例为1.8%，Angioseal组为1.1%，Perclose组为1.2%（p=无显著性差异）；严重并发症在手动压迫组患者中的发生率为1.3%，Angioseal组为1.1%，Perclose组为1.0%（p=无显著性差异）。多因素逻辑回归分析仅确定闭合装置失败是血管并发症的独立预测因素。在使用闭合装置成功闭合的患者中，与手动压迫相比，轻微并发症（0.8%对1.8%，p<0.05）及任何并发症（1.5%对2.5%，p<0.05）的发生率均有所降低。