Outcome of access site in patients treated with platelet glycoprotein IIb/IIIa inhibitors in the era of closure devices

Catheter Cardiovasc Interv. 2003 Jan;58(1):1-5. doi: 10.1002/ccd.10384.


The most consistent procedural predictor of vascular access site complications thus far has been the intensity and duration of anticoagulant therapy during and after percutaneous coronary interventions (PCI). Several devices have been developed to aid in the closure of the femoral arteriotomy. This report describes the clinical outcome of unsuccessful deployment of femoral closure devices in a cohort of 285 consecutive patients who underwent PCI and were treated with platelet glycoprotein (GP) IIb/IIIa inhibitors. Manual femoral artery compression was used in 123 patients, Perclose in 123 patients, and AngioSeal in 39 patients. Successful homeostasis was achieved in 98.4% of patients who received manual compression, in 91.9% of the Perclose-sealed arteriotomy, and in 84.6% of patients who received the AngioSeal closure device (P = 0.004). The incidence of vascular complications after successful deployment was 9%. Patients not achieving hemostasis with closure device or 1 degrees manual compression developed complications in the majority of cases (> 80%; P < 0.05). By multivariate analysis (with adjustment for baseline differences), the use of AngioSeal closure device was found to be an independent risk factors leading to primary deployment failure and all access site complications (OR 2.97; 95% CI 1.5-6.0; P = 0.006). In summary, failed hemostasis by artery closure devices in patients undergoing PCI who are treated with GP IIb/IIIa inhibitors is associated with significant vascular complications. AngioSeal may be associated with a higher failure rate, while manual compression and Perclose seem to be more effective with a lower complication rate.

MeSH terms

  • Abciximab
  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Catheters, Indwelling / adverse effects*
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Equipment Failure
  • Female
  • Femoral Artery / drug effects
  • Femoral Artery / surgery
  • Humans
  • Immunoglobulin Fab Fragments / administration & dosage*
  • Immunoglobulin Fab Fragments / adverse effects*
  • Immunoglobulin Fab Fragments / therapeutic use
  • Male
  • Middle Aged
  • Myocardial Ischemia / drug therapy*
  • Myocardial Ischemia / surgery*
  • Outcome Assessment, Health Care*
  • Platelet Aggregation Inhibitors / administration & dosage*
  • Platelet Aggregation Inhibitors / adverse effects*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Glycoprotein GPIIb-IIIa Complex / administration & dosage*
  • Platelet Glycoprotein GPIIb-IIIa Complex / adverse effects*
  • Platelet Glycoprotein GPIIb-IIIa Complex / therapeutic use
  • Postoperative Complications*
  • Retrospective Studies
  • Time Factors
  • Tirofiban
  • Tyrosine / administration & dosage*
  • Tyrosine / adverse effects*
  • Tyrosine / analogs & derivatives
  • Tyrosine / therapeutic use
  • Vascular Diseases / etiology*


  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Tyrosine
  • Tirofiban
  • Abciximab