Triple antiplatelet therapy does not increase femoral access bleeding with vascular closure devices

Exaire, Jose E; Dauerman, Harold L; Topol, Eric J; Blankenship, James C; Wolski, Kathy; Raymond, Russell E; Cohen, Eric A; Moliterno, David J; the TARGET Investigators,

doi:10.1016/j.ahj.2003.07.019

« Previous Next »American Heart Journal
Volume 147, Issue 1 , Pages 31-34, January 2004

Triple antiplatelet therapy does not increase femoral access bleeding with vascular closure devices

Jose E Exaire, MD
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Harold L Dauerman, MD
- Department of Cardiovascular Medicine, University of Vermont, Burlington, Vt, USA
Eric J Topol, MD
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
James C Blankenship, MD
- Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, Pa, USA
Kathy Wolski
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Russell E Raymond, DO
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Eric A Cohen, MD
- Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
David J Moliterno, MD
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Ky, USA
- Reprint requests: David J. Moliterno, MD, Chief, Cardiovascular Medicine, University of Kentucky, 900 S Limestone St, 317 Health Sciences Building, Lexington, KY 40536-0200, USA.
the TARGET Investigators

Received 21 March 2003; accepted 24 July 2003.

Abstract

Background

The use of arteriotomy closure devices (CDs) to achieve hemostasis after femoral artery access in percutaneous coronary intervention is steadily increasing. However, the safety information with these devices in the era of triple antiplatelet therapy is limited.

Methods

We reviewed prospectively collected data from the Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial (TARGET), where all patients received aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitor therapy. At the treating physician's discretion, manual compression (MC) or a vascular hemostasis device was selected following femoral angiography. Patients receiving MC were to have sheaths removed 2 to 6 hours postprocedure when the activated clotting time was ≤ 175 seconds.

Results

Of 4809 patients, 4736 had femoral access, and 985 of these had a CD (Perclose 47%, Angio-Seal 43%, VasoSeal 5%, and other 5%). The MC and CD groups were similar regarding most demographic characteristics, including age, systolic blood pressure, and weight, but those with MC were more often female, diabetic, and had history of peripheral vascular disease. Patients with a CD had a lower ischemic event rate suggesting they were a lower risk cohort overall. There were no differences in major bleeding at the access site (0.4% vs 0.5%, P = .588), minor bleeding at the access site (1.9% vs. 3.1%, P = .142) or transfusions (0.8% vs 1.0%, P = .513) between the MC and CD groups, respectively.

Conclusions

In contemporary percutaneous coronary intervention practice, with appropriate patient selection, a CD can be safely utilized despite aggressive polypharmacy for procedural anticoagulation.