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Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes.
Catheter Cardiovasc Interv. 2009 Sep 01; 74(3):408-15.CC

Abstract

OBJECTIVES

To analyze the effectiveness of the transradial approach in reducing bleeding rates following urgent percutaneous coronary intervention (PCI) in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors (GPIs).

BACKGROUND

PCI and use of GPIs are recommended in acute coronary syndromes, but are strong predictors of severe hemorrhagic complications, which, in turn, are associated with reduced survival. The transradial approach represents a simple and effective solution to reduce vascular access site bleedings, particularly with GPIs.

METHODS

All consecutive patients undergoing urgent transradial PCI under GPI treatment were enrolled in the registry. No patients were excluded. In addition, we performed a case-matched comparison of the transradial versus transfemoral approach using propensity analysis to adjust for known risk factors for bleeding. The primary end point was the rate of bleedings, graded according to the Thrombolysis in Myocardial Infarction (TIMI) classification.

RESULTS

Five hundred thirty-one consecutive patients were prospectively enrolled in the registry. TIMI major, minor, and minimal bleedings were 0.2%, 1.7%, and 6.4%, respectively. Transfusion rate was 0.8%. After propensity-matched analysis, the transradial approach was associated with significantly lower rates of all types of bleedings, while the transfemoral approach was the strongest predictor of TIMI major/minor bleedings (odds ratio 6.67; 95% confidence interval 1.72-25; P = 0.006).

CONCLUSIONS

The transradial approach dramatically reduces access site bleedings, including TIMI major and minor bleedings, and transfusion rate, while preserving procedural success and clinical outcome. The transradial approach is an attractive solution to reduce bleeding complications in patients treated with GPIs.

Authors+Show Affiliations

Cardiothoracic and Vascular Department, Cardiology Unit, University of Pisa, Pisa, Italy. marcodecarlo@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19360863

Citation

De Carlo, Marco, et al. "Effectiveness of the Transradial Approach to Reduce Bleedings in Patients Undergoing Urgent Coronary Angioplasty With GPIIb/IIIa Inhibitors for Acute Coronary Syndromes." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 74, no. 3, 2009, pp. 408-15.
De Carlo M, Borelli G, Gistri R, et al. Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes. Catheter Cardiovasc Interv. 2009;74(3):408-15.
De Carlo, M., Borelli, G., Gistri, R., Ciabatti, N., Mazzoni, A., Arena, M., & Petronio, A. S. (2009). Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 74(3), 408-15. https://doi.org/10.1002/ccd.22008
De Carlo M, et al. Effectiveness of the Transradial Approach to Reduce Bleedings in Patients Undergoing Urgent Coronary Angioplasty With GPIIb/IIIa Inhibitors for Acute Coronary Syndromes. Catheter Cardiovasc Interv. 2009 Sep 1;74(3):408-15. PubMed PMID: 19360863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of the transradial approach to reduce bleedings in patients undergoing urgent coronary angioplasty with GPIIb/IIIa inhibitors for acute coronary syndromes. AU - De Carlo,Marco, AU - Borelli,Gabriele, AU - Gistri,Roberto, AU - Ciabatti,Nicola, AU - Mazzoni,Alessandra, AU - Arena,Marco, AU - Petronio,A Sonia, PY - 2009/4/11/entrez PY - 2009/4/11/pubmed PY - 2009/10/30/medline SP - 408 EP - 15 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 74 IS - 3 N2 - OBJECTIVES: To analyze the effectiveness of the transradial approach in reducing bleeding rates following urgent percutaneous coronary intervention (PCI) in patients with acute coronary syndromes treated with glycoprotein IIb/IIIa inhibitors (GPIs). BACKGROUND: PCI and use of GPIs are recommended in acute coronary syndromes, but are strong predictors of severe hemorrhagic complications, which, in turn, are associated with reduced survival. The transradial approach represents a simple and effective solution to reduce vascular access site bleedings, particularly with GPIs. METHODS: All consecutive patients undergoing urgent transradial PCI under GPI treatment were enrolled in the registry. No patients were excluded. In addition, we performed a case-matched comparison of the transradial versus transfemoral approach using propensity analysis to adjust for known risk factors for bleeding. The primary end point was the rate of bleedings, graded according to the Thrombolysis in Myocardial Infarction (TIMI) classification. RESULTS: Five hundred thirty-one consecutive patients were prospectively enrolled in the registry. TIMI major, minor, and minimal bleedings were 0.2%, 1.7%, and 6.4%, respectively. Transfusion rate was 0.8%. After propensity-matched analysis, the transradial approach was associated with significantly lower rates of all types of bleedings, while the transfemoral approach was the strongest predictor of TIMI major/minor bleedings (odds ratio 6.67; 95% confidence interval 1.72-25; P = 0.006). CONCLUSIONS: The transradial approach dramatically reduces access site bleedings, including TIMI major and minor bleedings, and transfusion rate, while preserving procedural success and clinical outcome. The transradial approach is an attractive solution to reduce bleeding complications in patients treated with GPIs. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/19360863/Effectiveness_of_the_transradial_approach_to_reduce_bleedings_in_patients_undergoing_urgent_coronary_angioplasty_with_GPIIb/IIIa_inhibitors_for_acute_coronary_syndromes_ L2 - https://doi.org/10.1002/ccd.22008 DB - PRIME DP - Unbound Medicine ER -