Author + information
- Zohair Raza,
- Maryam Mohammadi,
- Gautam Visweswaran,
- Abdul Waheed,
- S. Sadi Raza,
- Chuntao Wu and
- Ian Gilchrist
Radial and femoral artery access have distinctly different patterns of access site complications, but non-access site bleeding has been less investigated. This study was designed to determine the difference between radial access (RA) and femoral access (FA) in non access site bleeding (NASB) events among patients who needed long term anticoagulation therapy with warfarin.
Single center, retrospective review of patients (N=108) on anticoagulation who underwent heart catheterization by either RA (n=49) or FA (n=59). The frequency of NASB events between these groups was calculated. Both the groups were similar in baseline demographics including age, indication for the procedure, aspirin, clopidogrel, heparin and GpIIb/IIIA inhibitor use. NASB was defined as a decrease in hemoglobin (Hb) g/dl of two g/dl from the pre-procedural Hb or bleeding requiring a red blood cell (RBC) transfusion and evidence of a proven site of bleeding not involving the access site confirmed by physical exam or imaging. Distribution free methods were used to calculate inferential statistics.
The frequency of NASB events in the RA and FA groups was 4.1% and 16.9% respectively. The Mantel-Haenszel Odds ratio was 4.8 (p = 0.05). The RA and FA groups were stratified for cases that had NASB and there was no significant difference between mean INR, use of aspirin, clopidogrel and GpIIb/IIIa inhibitor use among these groups. The majority of the NASB events occurred in patients who were either newly started on warfarin after the catheterization or restarted on warfarin after holding for it pre procedurally (Pearson correlation of 0.877 p = 0.01). Bridging with low molecular weight heparin, when indicated, was not associated with increased NASB events (p = 0.12). The most common site for NASB was soft tissue (41.7%) and gastrointestinal (33.3%) followed by others (25%).
The RA as compared to the FA approach appears to be associated with fewer events of NASB among patients who need long term anticoagulation with warfarin. This difference may be associated with starting warfarin after the procedure either for warfarin-naïve patients or restarting after holding it before the procedure.
i2 Poster Contributions
McCormick Place South, Hall A
Saturday, March 24, 2012, 9:30 a.m.-Noon
Session Title: Vascular Access
Abstract Category: 24. Vascular Access, Closure Devices and Complications
Presentation Number: 2530-411
- 2012 American College of Cardiology Foundation