Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website http://www.cardiologyres.org

Original Article

Volume 10, Number 6, December 2019, pages 331-335

Expedited Removal of a Radial Hemostatic Compression Device Following Cardiac Catheterization Is Safe and Associated With Reduced Time to Discharge

Figure 1. Compression device removal protocol times. This bar graph shows the compression, weaning, and post-removal observation times for patients in our study protocol in each of the three groups studied.

Figure 2. Bleeding and hematoma events grouped by weaning phase. As described in the methods section, hemostatic compression devices (HCDs) were removed with three serial deflations of one-third of the volume of air in the HCD cushion, 15 min apart, constituting phase 1 - 3 of the weaning protocol. Bleeding or hematoma could be noted during each of these phases, once the HCD was physically removed, or after the HCD was removed but before the patient was discharged.

Figure 3. Time to discharge from HCD application. These cumulative frequency distributions illustrate how much time elapsed between hemostatic compression device (HCD) application and discharge for each of the three groups evaluated. Patients in the 1-h and 0.5-h weaning groups were discharged sooner than in the 2-h weaning group (P < 0.001 and P < 0.01, respectively, by Wilcoxon test). There was no significant difference between the 1-h and 0.5-h groups (P = NS by Wilcoxon test.) NS: not significant.

**Table 1.** Baseline Characteristics^a
Characteristic	All groups	2-h wean	1-h wean	0.5-h wean
PCI: percutaneous coronary intervention; ACT: activated clotting time (in seconds). ^aThere were no statistically significant differences among the variables listed across groups as assessed by analysis of variance and t-tests for all possible individual comparisons for the continuous variables and for Fisher’s exact test for the categorical variables. ^bIn cases where heparin was not used, either bivalirudin or no anticoagulation was used.
N	354	99	132	123
Age (mean)	67	67	67	66
Gender (% male)	65%	64%	64%	66%
Procedure type
Coronary angiography	81%	80%	80%	85%
PCI	17%	20%	18%	13%
Other	2%	0%	2%	2%
Heparin use^b	96%	96%	98%	94%
ACT performed	23%	21%	21%	25%
ACT (mean)	247	260	246	238

Table 1. Baseline Characteristics^a

Characteristic

All groups

2-h wean

1-h wean

0.5-h wean

PCI: percutaneous coronary intervention; ACT: activated clotting time (in seconds). ^aThere were no statistically significant differences among the variables listed across groups as assessed by analysis of variance and t-tests for all possible individual comparisons for the continuous variables and for Fisher’s exact test for the categorical variables. ^bIn cases where heparin was not used, either bivalirudin or no anticoagulation was used.

354

132

123

Age (mean)

Gender (% male)

65%

64%

66%

Procedure type

Coronary angiography

81%

80%

85%

PCI

17%

20%

18%

13%

Other

Heparin use^b

96%

98%

94%

ACT performed

23%

21%

25%

ACT (mean)

247

260

246

238

**Table 2.** Outcomes by Group
Outcome	All groups	2-h wean	1-h wean	0.5-h wean	P value^a
Serious complications were defined as a composite of severe discomfort, severe hematoma, need for blood transfusion, surgical consultation, or unplanned admission. Times are listed as median values with the interquartile range in brackets. ^aCalculated using Fisher’s exact test for dichotomous variables and the Kruskal-Wallis test for time-to-event variables for all three groups. HCD: hemostatic compression device; NS: not significant.
Serious complications	0	0	0	0	-
Any bleeding, n, (%)	49 (14%)	8 (8%)	26 (19%)	15 (12%)	P = 0.032
Any hematoma, n, (%)	18 (5%)	3 (3%)	7 (5%)	8 (7%)	P = NS
Bleeding or hematoma, n, (%)	58 (16%)	11 (11%)	27 (20%)	20 (16%)	P = NS
Time to HCD removal (h)	2.1 (2.8 - 1.8)	2.9 (3.2 - 2.8)	2 (2.3 - 1.8)	1.6 (1.8 - 1.4)	P < 0.001
Time to discharge (h)	3.2 (4 - 2.7)	3.5 (4.3 - 3.2)	3.0 (3.7 - 2.5)	3.0 (3.9 - 2.5)	P < 0.001

Table 2. Outcomes by Group

Outcome

All groups

2-h wean

1-h wean

0.5-h wean

P value^a

Serious complications were defined as a composite of severe discomfort, severe hematoma, need for blood transfusion, surgical consultation, or unplanned admission. Times are listed as median values with the interquartile range in brackets. ^aCalculated using Fisher’s exact test for dichotomous variables and the Kruskal-Wallis test for time-to-event variables for all three groups. HCD: hemostatic compression device; NS: not significant.

Serious complications

Any bleeding, n, (%)

49 (14%)

8 (8%)

26 (19%)

15 (12%)

P = 0.032

Any hematoma, n, (%)

18 (5%)

3 (3%)

7 (5%)

8 (7%)

P = NS

Bleeding or hematoma, n, (%)

58 (16%)

11 (11%)

27 (20%)

20 (16%)

P = NS

Time to HCD removal (h)

2.1 (2.8 - 1.8)

2.9 (3.2 - 2.8)

2 (2.3 - 1.8)

1.6 (1.8 - 1.4)

P < 0.001

Time to discharge (h)

3.2 (4 - 2.7)

3.5 (4.3 - 3.2)

3.0 (3.7 - 2.5)

3.0 (3.9 - 2.5)

P < 0.001

**Table 3.** Rates of Bleeding/Hematoma Stratified by Procedure Type
Event	Diagnostic angiogram only	Percutaneous coronary intervention	Other	P value^a
NS: not significant. ^aCalculated using Fisher’s exact test.
Any bleeding, n, (%)	38 (13%)	10 (8.5%)	1 (17%)	P = NS
Any hematoma, n, (%)	13 (4.5%)	5 (8.5%)	0 (0%)	P = NS
Any bleeding or hematoma, n, (%)	45 (15.5%)	12 (19.7%)	1 (16.7%)	P = NS
Total patients	289	59	6	-

Table 3. Rates of Bleeding/Hematoma Stratified by Procedure Type

Event

Diagnostic angiogram only

Percutaneous coronary intervention

Other

P value^a

NS: not significant. ^aCalculated using Fisher’s exact test.

Any bleeding, n, (%)

38 (13%)

10 (8.5%)

1 (17%)

P = NS

Any hematoma, n, (%)

13 (4.5%)

5 (8.5%)

0 (0%)

P = NS

Any bleeding or hematoma, n, (%)

45 (15.5%)

12 (19.7%)

1 (16.7%)

P = NS

Total patients

289