Crossover da terapia com heparina e risco de sangramento na intervenção coronária percutânea transradial na síndrome coronária aguda

Abstract

Background: Radial access is effective in reducing bleeding complications in percutaneous coronary interventions (PCI). In acute coronary syndromes (ACS), the crossover from low molecular weight to unfractioned heparin increases the risk of bleeding after transfemoral PCI. The aim of this study was to evaluate the incidence of bleeding in patients with ACS undergoing PCI using the radial approach according to the occurrence or not of crossover of heparin therapy. Methods: Observational study of patients with ACS under going PCI using the radial access, divided into groups: A (with crossover) and B (without crossover). Bleeding events were classified according to GUSTO criteria; EASY criteria were used for bleeding events in the radial access. Results: We included 140 consecutive patients, 74 in group A and 66 in group B, with mean age of 59.7 ± 9.4 years, 72.8% were male, and 21.4% diabetic. There were six cases of bleeding complications (4.3%), and two (1.4%) were classified by GUSTO as moderate (one digestive bleeding and one femoral bleeding after intraaortic balloon pump), and four (2.9%) were classified as mild (hematomas with diameter ≤ 5 cm). In the comparison between groups, mod erate bleeding occurred in 1.3% in group A and 1.5% in group B (P = 0.49) and mild bleedings in 2.7% and 3.1% in groups A and B, respectively (P = 0.37). Conclusions: In this cohort of patients with ACS undergoing PCI using the radial access, a low incidence of bleeding events was observed, and most of these bleeding complications resulted from small hematomas of the access route. Crossover of

Comparação do Tempo de Fluoroscopia Durante Cateterismo Cardíaco pelas Vias Radial e Femoral

“…In this context, an interesting observation about the radial route is the possibility of a more liberal use of anticoagulants by the interventional cardiologist, due to the safety provided by this route regarding bleeding events at the puncture site. 1,12,13 In fact, both the clinical situation and the experience of the center in the use of the radial route appear to affect the results of PCI. In the multicenter Radial Versus Femoral Access for Coronary Intervention (RIVAL) study, with 7,021 patients, the combined outcome of death, myocardial infarction, stroke, and major bleeding not related to coronary artery bypass surgery was similar in both radial and femoral groups (3.7% vs. 4%, p = 0.50); but there was a significant benefit in favor of the radial route in centers with higher volume of procedures performed via this route (relative risk [RR] = 0.49; 95% confidence interval [95% CI]: 0.28-0.87; p = 0.015) and for patients with AMIWST (RR = 0.60; 95% CI: 0.38-0.94; p = 0.026).…”