Hemorrhagic complications during percutaneous coronary interventions: prospective analysis of 270 cases

Objectives

To analyze the incidence of hemorrhagic complications related to interventional coronary percutaneous procedures and associations with different variables: interventional techniques, demographic data and pharmacological adjuvant treatment.

Materials and method

A total of 270 patients (183 men and 87 women, mean age 62.6 ± 12.5 years and 71.8 ± 10.6, respectively; P < 0.00001) underwent 270 percutaneous coronary procedures. The following data were registered and correlated to vascular complications: diagnostic coronary angiography, percutaneous coronary angioplasty (PTCA), clinical features (diagnosis, coronary risk factors), antithrombotic therapy, activated coagulation time (ACT), sheath diameter and manipulation of puncture site.

Results

There were 45.7% with a diagnosis of unstable angina, 40.8% with acute myocardial infarction and 11.3% with stable angina. Smoking was observed in 49% of men and 19% of women (P = 0.001). No significant statistical differences were observed in relation to other variables. Incidence of hematomas (HMT) was higher among women before (P = 0.01) and after (P = 0.04) sheath removal, associated with higher platelet depletion (P = 0.004) and higher heparin dose (HD; P = 0.04), but not with hemoglobin reduction (P = 0.08). Among patients with HMT, HD was higher (P = 0.04), stents were more used (P = 0.02), larger sheaths (P = 0.015), and more prolonged initial ACT (P = 0.04), sheath maintenance (P = 0.005), ASA (P = 0.04) and ticlopidine therapy (P = 0.003), and hemodynamic instability (HI; P = 0.005). There was no correlation between abciximab and HMT.

Conclusion

Higher incidence of HMT was detected among women and was associated with older age, higher HD, higher Hb and platelet depletions, larger sheath diameter, larger time of sheath maintenance, use of ASA/ticlopidine, ACT and HI. Initial diagnosis, risk factors, procedure duration and use of abciximab did not correlate with HMT.