NEW YORK (Reuters Health) – After percutaneous coronary intervention via the femoral artery, use of arterial closure devices rather than manual compression reduces the rate of major bleeding complications and pseudoaneurysms.

That’s according to a study by a team at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and published in the American Journal of Cardiology online March 21.

Dr. David M. Safley and colleagues examined bleeding events that required transfusion, prolonged hospital stays, or that led to a drop in hemoglobin of >3.0 g/dL, in patients who underwent PCI via the femoral approach at a single institution.

Propensity matching yielded 2324 patients; i.e., 1162 patients who had arterial closure devices were matched to 1162 who had manual compression for hemostasis after the procedure.

The rate of major bleeding was lower in arterial-closure-device patients compared to manual-compression patients (2.4% vs 5.2%; p <0.001), the investigators found. Pseudoaneurysms were also fewer (0.3% vs 1.1%) in the two groups, respectively, and length of stay was shorter at 1.9 days vs 2.3 days. Furthermore, Dr. Safley and colleagues report, “Patients at highest risk for bleeding appear to have the greatest decrease in risk with arterial closure device use.” Patients at low or moderate risk had consistent risk reductions with closure devices compared with manual compression, but these differences were not significant. A secondary analysis compared types of arterial closure devices — collagen-plug (n = 741) versus suture-based device (n = 421). The composite end point of major bleeding, vascular occlusion, significant dissection, pseudoaneurysm, or arteriovenous fistula development at the access site and peripheral embolization was lower with suture-based devices than collagen plugs (1.4% vs 3.4%; p= 0.048), according to the report. The reduction in major bleeding in the patients having arterial closure devices after PCI “is a significant finding,” the authors conclude. They add, “Our study was not developed, or powered, to detect a mortality benefit in this PCI population. However, these results may justify further evaluation of this potential benefit of arterial closure devices.” Am J Cardiol 2011.