Six hour ambulation after elective coronary angioplasty and stenting with 7F guiding catheters ald low dose heparin.

BACKGROUND

Early ambulation after coronary angioplasty may reduce in-hospital stay and add to the patient's comfort. This approach, however, may increase the risk of insertion site related complications, such as arterial bleeding, haematoma, pseudoaneurysm, and the need for surgical repair.

AIM

To evaluate the feasibility and safety of ambulation of patients six hours after elective coronary angioplasty or stenting, or both.

METHODS

Coronary angioplasty and stenting were performed using 7F guiding catheters via the femoral or brachial approach. The first dose of heparin 5000 IU was given immediately after insertion of the arterial sheath and the second dose heparin 2500 IU was given 90 minutes later. There were no angiographic exclusion criteria. The arterial sheath was removed immediately after the procedure. Haemostasis was achieved by manual compression and maintained with a compression bandage. Early ambulation was attempted after six hours of supine bed rest following removal of the bandage. The incidence of bleeding at ambulation requiring compression and additional bed rest, and insertion site complications documented 48 hours after the procedure, were analysed.

RESULTS

326 patients (290 femoral, 36 brachial route) were included. Stent implantation was performed in 267 patients (82%). The mean+/-SD time to haemostasis was 14+/-4 minutes. Bleeding at ambulation occurred in 7 (2.14%) patients, and major haematomas were seen in 8 (2.45%) patients during 48-hour follow up. All were seen in patients in whom the femoral route was used and who were treated conservatively. There were no late bleeding or vascular complications.

CONCLUSIONS

Ambulation six hours after elective balloon angioplasty or stent implantation with 7F guiding catheters using femoral or brachial route and low dose heparin is feasible and safe, with a low incidence of insertion site complications. This early ambulation protocol shortens hospital stay.