Comparison of manual compression and vascular hemostasis devices after coronary angiography or percutaneous coronary intervention through femoral artery access: A meta-analysis of randomized controlled trials

摘要

ObjectivesTo compare the efficacy and safety of manual compression (MC) with vascular hemostasis devices (VHD) in patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) through femoral artery access. IntroductionThe use of femoral artery access for coronary procedures may result in access-related complications, prolonged immobility and discomfort for the patients. MC results in longer time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to VHDs but its role in access-related complications remains unclear in patients undergoing coronary procedures. MethodsWe searched MEDLINE, EMBASE, Cochrane CENTRAL and relevant references for English language randomized controlled trials (RCT) from inception through September 30, 2016. We performed the meta-analysis using random effects model. The outcomes were time-to-hemostasis, time-to-ambulation, major bleeding, large hematoma >5cm, pseudoaneurysm and other adverse events. ResultsThe electronic database search resulted in a total of 44 RCTs with a total of 18,802 patients for analysis. MC, compared to VHD resulted in longer TTH [mean difference (MD): 11.21min; 95% confidence interval (CI) 8.13–14.29;P 5cm formation [risk ratio (RR): 1.38 (1.15–1.67);P=0.0008]. MC resulted in similar risk of major bleeding [1.01 (0.64–1.60);P=0.95] pseudoaneurysm [0.99 (0.75–1.29);P=0.92], infections [0.52 (0.25–1.10);P=0.09], need of surgery [0.60 (0.29–1.22);P=0.16), AV fistula [0.93 (0.68–1.27);P=0.63] and ipsilateral leg ischemia [0.95 (0.57–1.60);P=0.86] compared to VHD. ConclusionManual compression increase time-to-hemostasis, time-to-ambulation and risk of hematoma formation compared vascular hemostasis devices.