Ignite Creation Date:
2024-05-05 @ 12:11 PM
Last Modification Date:
2024-10-26 @ 9:21 AM
Study NCT ID:
NCT00264264
Status:
COMPLETED
Last Update Posted:
2013-05-16
First Post:
2005-12-08
Brief Title:
Arterial Closure vs Direct Compression for Hemostasis After PCI - The ACDC Trial
Sponsor:
Unity Health Toronto
Organization:
Unity Health Toronto
Study Overview
Official Title:
Arterial Closure vs Direct Compression for Hemostasis After Percutaneous Coronary Interventions
Status:
COMPLETED
Status Verified Date:
2013-05
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Hemostasis at the arterial puncture site after percutaneous coronary interventions is achieved by either placement of a puncture closure device or by delaying sheath removal for hours to allow normalization of heparin induced anticoagulation Both of these methods are far from ideal Delayed sheath removal poses a risk of recurrent bleeding hematoma formation and results in decreased patient mobility while the safety of closure devices has been called into question by several recent reports Due to the lack of definitive data the arterial access site management varies considerably between physicians and among institutions The proposed study will evaluate the safety and efficacy of arterial closure devices to achieve hemostasis compared with immediate sheath removal after protamine administration followed by direct compression after percutaneous coronary intervention procedures
Detailed Description:
Percutaneous coronary intervention PCI is the most common procedure performed for obstructive coronary artery disease with more than one million procedures performed annually in United States alone1 Despite major advances in technology and operative expertise the optimum management of arterial access site after PCI procedures remains unclear
The conventional practice of arterial access site management involves delaying of sheath removal for several hours to allow normalization of heparin induced anticoagulation This delayed sheath removal poses a risk of recurrent bleeding and hematoma formation Furthermore delayed sheath removal results in decreased patient mobility increased patient discomfort and requires frequent monitoring with an impact on nursing resources The risks associated with delayed sheath removal may be further increased by concomitant administration of potent anti platelet therapy now routinely used in patients undergoing PCI2
Arterial puncture closure devices APCD were developed to obtain immediate arterial access site hemostasis after closed vascular procedures with an aim towards early patient mobilization Although the efficacy of APCD have been documented in several small studies but limited information is available regarding their safety in diverse patient populations A recent meta analysis has shown increased vascular complication rate associated with the use of these devices bringing the safety of their routine use into question3
Due to lack of definitive data the arterial access site management varies considerably between physicians and among institutions APCD are routinely used by some centers4 while others continue to delay arterial sheath removal for several hours after the procedure5
Immediate sheath removal followed by direct compression though routinely practiced after coronary angiographic procedures is not used after PCI procedures due to the intra procedural administration of heparin resulting in prolonged anticoagulation Reversal of heparin with protamine may allow immediate sheath removal resulting in early patient ambulation and decreased access site vascular complications The safety and efficacy of intravenous protamine administration for reversal of heparin is well established by its routine use in cardiovascular surgery for several decades6 and recent reports showing safety and efficacy of this method for early sheath removal after PCI procedures7-9
The proposed study is designed to evaluate the safety and efficacy of immediate sheath removal followed by direct compression as compared to the use of APCD to achieve hemostasis after PCI
The conventional practice of arterial access site management involves delaying of sheath removal for several hours to allow normalization of heparin induced anticoagulation This delayed sheath removal poses a risk of recurrent bleeding and hematoma formation Furthermore delayed sheath removal results in decreased patient mobility increased patient discomfort and requires frequent monitoring with an impact on nursing resources The risks associated with delayed sheath removal may be further increased by concomitant administration of potent anti platelet therapy now routinely used in patients undergoing PCI2
Arterial puncture closure devices APCD were developed to obtain immediate arterial access site hemostasis after closed vascular procedures with an aim towards early patient mobilization Although the efficacy of APCD have been documented in several small studies but limited information is available regarding their safety in diverse patient populations A recent meta analysis has shown increased vascular complication rate associated with the use of these devices bringing the safety of their routine use into question3
Due to lack of definitive data the arterial access site management varies considerably between physicians and among institutions APCD are routinely used by some centers4 while others continue to delay arterial sheath removal for several hours after the procedure5
Immediate sheath removal followed by direct compression though routinely practiced after coronary angiographic procedures is not used after PCI procedures due to the intra procedural administration of heparin resulting in prolonged anticoagulation Reversal of heparin with protamine may allow immediate sheath removal resulting in early patient ambulation and decreased access site vascular complications The safety and efficacy of intravenous protamine administration for reversal of heparin is well established by its routine use in cardiovascular surgery for several decades6 and recent reports showing safety and efficacy of this method for early sheath removal after PCI procedures7-9
The proposed study is designed to evaluate the safety and efficacy of immediate sheath removal followed by direct compression as compared to the use of APCD to achieve hemostasis after PCI
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None