Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2021 Feb;83(1):125-133. doi: 10.18999/nagjms.83.1.125.
Puncture site hemorrhage following femoral artery catheterization is a significant cause of morbidity. The aim of this case-control study was to identify predictors of postprocedural arterial hemorrhage at the puncture site. We retrospectively reviewed 255 patients who underwent endovascular treatment at our institution over a 23-month period and classified them into a hemorrhage group and a non-hemorrhage group. Puncture site hemorrhage occurred in 15 patients (5.9%). Clinical factors associated with a significantly increased risk of puncture site bleeding included patients whose postoperative activated clotting time of ≥300 seconds before removal of the sheath (9 patients, 11.8%; P<0.05), those who received triple antiplatelet therapy (n=4, 17.4%; P<0.05) and the group administered heparin postoperatively (7 patients, 13.2%; P<0.05). The effects of low on-treatment platelet reactivity, i.e., P2Y12 reaction units <95%, sheath size, hemostasis method used, and operating time were not clinically significant. Our findings suggest an increased risk of puncture site hemorrhage in patients who either had an activated clotting time ≥300 seconds before the postoperative removal of the sheath, had received triple antiplatelet therapy, or were administered heparin postoperatively.
股动脉导管插入术后穿刺部位出血是发病率的一个重要原因。本病例对照研究的目的是确定术后穿刺部位动脉出血的预测因素。我们回顾性分析了 255 例在我院接受血管内治疗的患者，将其分为出血组和非出血组。15 例（5.9%）患者发生穿刺部位出血。与穿刺部位出血风险显著增加相关的临床因素包括术后拔除鞘管前活化凝血时间≥300 秒的患者（9 例，11.8%；P<0.05）、接受三联抗血小板治疗的患者（n=4，17.4%；P<0.05）和术后给予肝素的患者（7 例，13.2%；P<0.05）。低治疗血小板反应性（即 P2Y12 反应单位<95%）、鞘管大小、止血方法和手术时间的影响无临床意义。我们的研究结果表明，术后拔除鞘管前活化凝血时间≥300 秒、接受三联抗血小板治疗或术后给予肝素的患者，穿刺部位出血风险增加。
