Retirada precoce de introdutor arterial guiada pelo tempo de coagulação ativada após intervenção coronária percutânea

Abstract

A intervenção coronária percutânea (ICP), técnica de revascularização miocárdica mais empregada no tratamento da cardiopatia isquêmica 1-4 , é realizada sob anticoagulação e antiagregação plaquetária combinadas e a heparina não-fracionada (HNF) é, em nosso meio, o anticoagulante mais utilizado nesse cenário. A ação antitrombótica da HNF pode ser monitorizada na sala de hemodinâmica pelo tempo de coagulação ativada (TCA). Preconiza-se medida de TCA entre 250 segundos e 350 segundos para a realização da ICP e < 200 segundos para a retirada do introdutor arterial. 5-11 ABSTRACT Early Arterial Sheath Removal Guided by Activated Clotting Time after Percutaneous Coronary InterventionBackground: Activated clotting time (ACT) can be used for early arterial sheath removal after femoral-approach percutaneous coronary intervention (PCI). This study compared the time for arterial sheath removal, with and without ACT guidance, and bed rest after PCI. Methods: Randomized clinical trial including 78 patients submitted to elective PCI, allocated for ACT-guided (group 1) and non-ACT-guided (group 2) arterial sheath removal. In group 1, the sheath was removed when ACT was < 180 seconds. After removal of the arterial sheath, patients remained at bed rest for 6 hours in both groups. Results: Mean age was 60 ± 9 years and 57% of the patients were men. Groups were similar for clinical characteristics, coronary lesion complexity, arterial sheath caliber, number and type of stents used, drugs used and success rates. The time for arterial sheath removal (95 ± 35 minutes vs. 240 ± 16 minutes; P < 0.01) and bed rest (454 ± 33 minutes vs. 600 ± 12 minutes; P < 0.01) were significantly lower in group 1. Conclusions: Arterial sheath removal guided by ACT in patients undergoing PCI was performed earlier and allowed a reduction of the overall time of bed rest when compared to the institutional standard procedure.