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Vascular access site complications after PCI: current status and future directions

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 402–403 (2006)Cite this article

The use of combined antithrombotic therapies over the last two decades has substantially decreased the risk of a heart attack after percutaneous coronary intervention (PCI) but has also been associated with a significant increase in bleeding risk.1 Therapies or strategies that maintain the benefits seen with currently available antithrombotic therapies, but which have lower bleeding risk, are therefore of great clinical importance. Indeed, major bleeding is currently the most common noncardiac complication for patients who have undergone PCI for the treatment of coronary artery disease. PCI-related bleeding occurs mainly at the arterial or venous puncture site. The procedure is consistently associated with a greatly increased risk of death during clinical follow-up, as reported in many contemporary pharmacoinvasive trials and registries.1 In the US, more than 5% of patients who undergo PCI require transfusion, and a further 13%, approximately, experience minor bleeding.2 The reduction of vascular access site complications in PCI procedures is, therefore, a critical challenge, and several strategies to reach this goal have been developed in the past few years. In this perspective, the radial access approach compares favorably with the femoral approach (meta-analysis of 12 randomized trials including 3,224 patients;3 odds ratio 0.20, 95% CI 0.09–0.42; P <0.0001) and could provide an unique opportunity to simply and drastically reduce a significant part of the bleeding complications recognized to be associated with dismal patient prognosis.

In the contemporary pharmacologic environment, bleeding and vascular access site complications remain major issues. The OASIS 54 and STEEPLE trial5 findings give us interesting, up-to-date data in the settings of PCI for non-ST-segment elevation acute coronary syndromes and planned PCI, respectively. In the OASIS 5 study, which compared fondaparinux with low-molecular-weight heparin (LMWH), the major adverse cardiac event rate at 9 days was similar in the two treatment groups. Major bleeding complications and vascular access site complications (the majority of which were femoral access-related) were reduced significantly with fondaparinux; however, although reduced, the vascular access site complication rate was still 3.3%. In the STEEPLE trial, which compared LMWH with unfractionated heparin after femoral-access PCI, once again there was no difference in ischemic endpoints between the two groups; however, there was a significant reduction in bleeding complications with LMWH (8.7% with unfractionated heparin versus 6% with LMWH), mainly related to access site complications.

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  1. Professor of Cardiology and Codirector of the Interventional Cardiology Department at the University Hospital of Caen, Normandy, France

    Martial Hamon

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  1. Martial Hamon
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Correspondence to Martial Hamon.

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Hamon, M. Vascular access site complications after PCI: current status and future directions. Nat Rev Cardiol 3, 402–403 (2006). https://doi.org/10.1038/ncpcardio0607

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