evidence based practice

I need some assistance with these assignment. evidence based practice Thank you in advance for the help! Four articles were analyzed to answer the question, “In patients receiving stents via cardiac catheterization, will insertion of a vascular closure device (VCD), as compared to the current standard of care (manual compression (MC)), increase the risk of bleeding?” Because this would like to determine harm from a procedure, studies on these are most likely retrospective, cohort studies. In the study by Arora, Matheny, Sepke & Resnic (2007) of 6, 913 patients who underwent percutaneous coronary intervention (PCI) via femoral access, VCD use (n = 5, 962) resulted to a significantly lower rates of minor vascular complications (1.6% vs. 3.0%), particularly hematoma (1.1% vs. 2.5%) and pseudoaneurysm (0.1% vs. 1.0%), as compared to MC use (n = 951). Odds ratio of developing complications for VCD recipients was 0.56 (95% CI: 0.40 – 0.79). Because baseline characteristics between treatment groups were initially different, statistical adjustment was done.

In 2010, a prospective, small-scale, short-term case-series study involving 413 patients treated of acute coronary syndrome was used to identify predictors of vascular complications. The use of VCDs by the sample was fairly limited, only 62 used Angio-Seal and 19 had PerClose. For those who used VCDs, there were no significant differences in the occurrence of hematoma during or after the use of procedure. In addition, those with complications were old and had significantly higher systolic blood pressure, as compared to those that did not have complications (Sulzbach-Hoke, Ratcliffe, Kimmel, Kolansky, & Polomano, 2010).

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The different VCDs were also compared. In patients that have received PCI in the past eight years, those who underwent VCD (n = 2, 814) had significantly lower incidence rate of ≥ 10 cm hematoma as compared to those who were given MC (n = 1, 407), 1.1% vs. 2.1%. Baseline characteristics between VCD and MC groups were not statistically different. Comparison among Angio-Seal, Perclose and Starclose users revealed that those who used Perclose had the least rate of complications (5.6%), while those receiving Starclose had the most (10.2%). The differences among rates were significant (Iqtidar, Li, Mather, & McKay, 2011).

A similar, wider scale, retrospective study (n = 1, 819, 611) was conducted 2012 by Tavris, et al. The rates of bleeding in Angio-Seal (28.7%), Perclose (8.3%), Boomerang Closure Wire (BCW) (0.6%) and hemostasis patches (7.9%) VCDs were less than 1%, while those receiving MC (38.9%) was 1.18%. In contrast, StarClose (4.4%) and Mynx (1.3%) VCDs had bleeding rates of 1.12% and 1.07%, respectively. As a result, there is decreased risk of bleeding of Angio-Seal, Perclose, BCW, and patches, with odds ratios of 0.84 (95% CI: 0.80-0.87), 0.69 (95% CI: 0.65-0.74), 0.98 (95%CI: 0.78-1.22), and 0.92 (95% CI: 0.86-0.98), respectively. In contrast, StarClose, BCW and Mynx resulted to equivocal or increased risk of bleeding, with odds ratios of 1.05 (95% CI: 0.98-1.13), 0.98 (95% CI: 0.78-1.22), and 1.32 (95% CI: 1.16-1.50), respectively.

Based on these four articles, it seemed that only certain brands of VCDs, particularlyPerClose, as proven by two of these four, decrease the risks for complications for bleeding and other vascular adverse events. On the other hand, brands such as StarClose presented a greater risk for bleeding, as compared to manual compression.

References

Arora, N., Matheny, M. E., Sepke, C., & Resnic, F. S. (2007). A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J, 153, 606-611.

Iqtidar, A. F., Li, D., Mather, J., & McKay, R. G. (2011). Propensity Matched Analysis of Bleeding and Vascular Complications Associated with Vascular Closure Devices vs Standard Manual Compression Following Percutaneous Coronary Intervention. Connecticut Medicine, 75(1), 5-10

Sulzbach-Hoke, L. M., Ratcliffe, S. K., Kimmel, S. E., Kolansky, D. M., & Polomano, R. (2010). Predictors of Complications Following Sheath Removal With Percutaneous Coronary Intervention. Journal of Cardiovascular Nursing, 25(3), 1-6

Tavris, D. R., et al. (2012). Bleeding and Vascular Complications at the Femoral Access Site

Following Percutaneous Coronary Intervention (PCI): An Evaluation of Hemostasis Strategies. J Invasive Cardiol, 24(7), 2-8.

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