TY - JOUR
T1 - Safety of transradial access compared to transfemoral access with hemostatic devices (vessel plugs and suture devices) after percutaneous coronary interventions
T2 - A systematic review and meta-analysis
AU - Chugh, Yashasvi
AU - Bavishi, Chirag
AU - Mojadidi, Mohammad K.
AU - Elgendy, Islam Y.
AU - Faillace, Robert T.
AU - Brilakis, Emmanouil S.
AU - Tamis-Holland, Jacqueline
AU - Mamas, Mamas
AU - Chugh, Sanjay Kumar
N1 - Funding Information:
E.S.B.: received consulting/speaker honoraria from Abbott Vascular, American Heart Association (associate editor Circulation), Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), CSI, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; research support from Regeneron and Siemens. Shareholder: MHI Ventures. The other authors declare no conflict of interest.
Publisher Copyright:
© 2020 Wiley Periodicals LLC.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objectives: Comparing the safety of transradial access (TRA) and conventional hemostasis with transfemoral access (TFA) and vascular closure devices (vessel plugs and suture devices) in patients undergoing percutaneous coronary interventions. Background: TRA for PCIs is associated with fewer bleeding and vascular complications compared with TFA. Vascular closure devices (VCD) are often used post TFA to establish early hemostasis and mitigate bleeding risk. However, the comparative efficacy of TRA and TFA with VCDs remains controversial. Method: Electronic database were systematically searched for all pertinent studies from inception through January 2020. Randomized studies, registry data, and abstracts published in peer-reviewed indexed journals were included. The short-term outcomes: major bleeding, vascular complications, and closure device failure were evaluated. Random-effects model was used to pool individual study results. Results: Twelve studies (8 observational, 4 randomized) including 7,961 patients (TRA: 3,121 patients, TFA and vessel plugs: 3,157 patients, TFA & suture devices: 1,683 patients) were included in the analysis. Major bleeding was significantly lower with TRA compared with TFA and vessel plugs (odds ratio [OR] 0.22, 95%CI 0.11–0.44, p <.00001) and TFA & suture devices (OR 0.12, 95%CI 0.05–0.28, p <.00001). Vascular complications were significantly lower with TRA compared to TFA and vessel plugs (OR 0.25, 95%CI 0.13–0.49, p <.0001) and TFA & suture devices (OR 0.13, 95%CI 0.04–0.41, p = 0.0005). Rates of closure device failure were lower for TRA compared to TFA & suture devices (OR 0.13, 95%CI 0.04–0.41, p =.0005), but similar to TFA & vessel plugs (OR 0.23, 95%CI 0.01–4.28, p =.33), although confidence intervals were wide. All analysis revealed a low to moderate level of heterogeneity. Conclusion: TRA with conventional hemostasis is safer than TFA with hemostasis via vessel plugs or suture devices and should be considered best practice.
AB - Objectives: Comparing the safety of transradial access (TRA) and conventional hemostasis with transfemoral access (TFA) and vascular closure devices (vessel plugs and suture devices) in patients undergoing percutaneous coronary interventions. Background: TRA for PCIs is associated with fewer bleeding and vascular complications compared with TFA. Vascular closure devices (VCD) are often used post TFA to establish early hemostasis and mitigate bleeding risk. However, the comparative efficacy of TRA and TFA with VCDs remains controversial. Method: Electronic database were systematically searched for all pertinent studies from inception through January 2020. Randomized studies, registry data, and abstracts published in peer-reviewed indexed journals were included. The short-term outcomes: major bleeding, vascular complications, and closure device failure were evaluated. Random-effects model was used to pool individual study results. Results: Twelve studies (8 observational, 4 randomized) including 7,961 patients (TRA: 3,121 patients, TFA and vessel plugs: 3,157 patients, TFA & suture devices: 1,683 patients) were included in the analysis. Major bleeding was significantly lower with TRA compared with TFA and vessel plugs (odds ratio [OR] 0.22, 95%CI 0.11–0.44, p <.00001) and TFA & suture devices (OR 0.12, 95%CI 0.05–0.28, p <.00001). Vascular complications were significantly lower with TRA compared to TFA and vessel plugs (OR 0.25, 95%CI 0.13–0.49, p <.0001) and TFA & suture devices (OR 0.13, 95%CI 0.04–0.41, p = 0.0005). Rates of closure device failure were lower for TRA compared to TFA & suture devices (OR 0.13, 95%CI 0.04–0.41, p =.0005), but similar to TFA & vessel plugs (OR 0.23, 95%CI 0.01–4.28, p =.33), although confidence intervals were wide. All analysis revealed a low to moderate level of heterogeneity. Conclusion: TRA with conventional hemostasis is safer than TFA with hemostasis via vessel plugs or suture devices and should be considered best practice.
KW - closure device
KW - meta-analysis
KW - transfemoral
KW - transradial
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U2 - 10.1002/ccd.29061
DO - 10.1002/ccd.29061
M3 - Article
C2 - 32521099
AN - SCOPUS:85086151226
SN - 1522-1946
VL - 96
SP - 285
EP - 295
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -