Comparison of conventional compressive dressings vs. wristband devices after catheterization by radial approach | Revista Brasileira de Cardiologia Invasiva (English Edition)

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Rotational atherectomy to the left anterior descending (B) and left circumflex (C) arteries. Stent implantation in the left anterior descending artery (D1 and D2), in the left main coronary artery, and in left circumflex (E). Angiographic result (F)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabela Pilar Moraes Alves de Souza, Bruno Macedo Aguiar, Joberto Pinheiro Sena, Paulo José Bastos Barbosa, José Carlos Raimundo Brito" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Isabela Pilar" "apellidos" => "Moraes Alves de Souza" ] 1 => array:2 [ "nombre" => "Bruno" "apellidos" => "Macedo Aguiar" ] 2 => array:2 [ "nombre" => "Joberto" "apellidos" => "Pinheiro Sena" ] 3 => array:2 [ "nombre" => "Paulo José" "apellidos" => "Bastos Barbosa" ] 4 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Raimundo Brito" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2214123517300108?idApp=UINPBA00004N" "url" => "/22141235/0000002300000004/v2_201705291657/S2214123517300108/v2_201705291657/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2214123517300157" "issn" => "22141235" "doi" => "10.1016/j.rbciev.2017.02.013" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "68" "copyright" => "Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Bras Cardiol Invasiva. 2015;23:266-70" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1243 "formatos" => array:3 [ "EPUB" => 315 "HTML" => 621 "PDF" => 307 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Independent predictors of multivessel coronary artery disease: results from Angiocardio Registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "270" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Preditores independentes de doença arterial coronária multiarterial: resultados do Registro Angiocardio" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcelo José de Carvalho Cantarelli, Hélio José Castello, Rosaly Gonçalves, Silvio Gioppato, João Batista de Freitas Guimarães, Evandro Karlo Pracchia Ribeiro, Julio Cesar Francisco Vardi, Danilo Maksud, Ednelson Cunha Navarro" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Marcelo" "apellidos" => "José de Carvalho Cantarelli" ] 1 => array:3 [ "nombre" => "Hélio José" "apellidos" => "Castello" "sufijo" => "Jr." ] 2 => array:2 [ "nombre" => "Rosaly" "apellidos" => "Gonçalves" ] 3 => array:2 [ "nombre" => "Silvio" "apellidos" => "Gioppato" ] 4 => array:2 [ "nombre" => "João" "apellidos" => "Batista de Freitas Guimarães" ] 5 => array:2 [ "nombre" => "Evandro Karlo" "apellidos" => "Pracchia Ribeiro" ] 6 => array:2 [ "nombre" => "Julio Cesar" "apellidos" => "Francisco Vardi" ] 7 => array:2 [ "nombre" => "Danilo" "apellidos" => "Maksud" ] 8 => array:2 [ "nombre" => "Ednelson" "apellidos" => "Cunha Navarro" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2214123517300157?idApp=UINPBA00004N" "url" => "/22141235/0000002300000004/v2_201705291657/S2214123517300157/v2_201705291657/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Comparison of conventional compressive dressings vs. wristband devices after catheterization by radial approach" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "275" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Said Assaf Neto, João Orávio de Freitas, Sérgio Luis Berti, J. Ribamar Costa, Jorge Augusto L. Zbeid" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Said Assaf" "apellidos" => "Neto" "email" => array:1 [ 0 => "said.assaf@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:4 [ "nombre" => "João Orávio" "apellidos" => "de Freitas" "sufijo" => "Jr." "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Sérgio Luis" "apellidos" => "Berti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "J. Ribamar" "apellidos" => "Costa" "sufijo" => "Jr." "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Jorge Augusto L." "apellidos" => "Zbeid" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Hospital Carlos Fernando Malzoni, Matão, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Santa Casa de São Carlos, São Carlos, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital São Paulo, Araraquara, SP, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author: Rua João Gurgel, 1.477, apto. 51 − Carmo − CEP: 14801-405 − Araraquara (SP), Brazil." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Comparação do curativo compressivo vs. pulseira hemostática após cateterização por via radial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1309 "Ancho" => 1744 "Tamanyo" => 221915 ] ] "descripcion" => array:1 [ "en" => "Placement of the conventional compressive dressing: externalization of the sheath is started after cuff inflation > 10mmHg of the patient's systolic blood pressure (A). Close to the sheath externalization, the dressing is positioned 1cm above the puncture site, applying manual pressure (B). Next, the first compression tape is placed (C), and then the dressing is completed in an “X” (D)." ] ] ] "textoCompleto" => "IntroductionThe use of radial access has become increasingly common in the contemporary scenario of percutaneous coronary intervention (PCI), given its superiority over the femoral access regarding the reduction of mortality, especially in acute coronary syndrome, as shown by several clinical trials.<a class="elsevierStyleCrossRefs" href="#bib0005">1–4</a> Additionally, this type of access is associated with lower rates of vascular complications/bleeding and promotes greater comfort for the patient.<a class="elsevierStyleCrossRefs" href="#bib0005">1,5–7</a>Aiming to make local hemostasis more practical after the use of radial approach, devices dedicated to puncture site compression have been recently developed. Although practical and effective, these devices add cost to the procedure and have not been adequately compared to the use of conventional compressive dressings, universally available and at a relatively low cost.The present study aimed to compare the effectiveness and safety of both forms of hemostasis of the radial puncture site in patients undergoing coronary angiography and/or PCI in daily practice.MethodsPopulation and study designThis is a prospective, multicenter, nonrandomized study including consecutive patients undergoing procedures through radial access. Patients older than 18 years undergoing elective diagnostic catheterization, elective PCI or cardiac catheterization, followed by percutaneous intervention (ad hoc), were included. The authors only excluded those patients with prior coronary artery bypass graft surgery and those who had cardiogenic shock at the time of examination.The use of dedicated wristband devices for hemostatic compression or compressive dressings was at the interventionist's discretion and the service's availability during the period of registry inclusion.Radial punctureAfter the radial puncture and passage of the sheath, a solution containing 5,000 IU of unfractionated heparin, 40mg of isosorbide mononitrate, and 2mL of lidocaine was infused into the radial artery.In cases of elective or ad hoc PCI, an additional dose of unfractionated heparin was administered, up to 100 IU/kg.Radial compression technique after sheath removalWristband deviceTwo models of transradial compression wristband devices were used: the TR Band® compressive device (Terumo Medical, Tokyo, Japan) or the RadiStop® device (St. Jude Medical, St. Paul, USA). According to the manufacturer's recommendations, the authors positioned the compression point approximately 1cm above the puncture site with balloon inflation using 15mL of air, after which the sheath was submitted to traction and removed, and then deflation was started at each 3mL, observing whether or not bleeding occurred. If blood extravasation was observed, a new insufflation was performed with 3mL of air and the patient kept the limb at rest for 1 hour. After this period, decompression was performed, with 3mL of air being withdrawn every 30minutes until complete deflation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Subsequently, a non-compressive dressing was maintained, followed by the recommendation to rest and return in 7 days.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Compressive dressingHemostasis was initiated with the inflation of the sphygmomanometer cuff in the arm, at 200mmHg, followed by removal of the sheath. Then, a gauze pad and four strips of micropore tape (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), in the shape of an “X”, were positioned. Over this first dressing, other gauze pads, previously folded into quadrangular shapes, were positioned and the compression dressing was performed with adhesive tape.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>After that, the cuff was deflated and, if bleeding or distal cyanosis was observed, the dressing was remade. Similarly to compression using the wristband device, the patient rested for 1 hour with the compressive dressing. After this period, the compressive tape was removed and a simple dressing with micropore tape was maintained.At the discharge, the patient received the same care and recommendations given to those who received compression wristband devices.Study objectives and definitionsThe primary objective of this analysis was to compare the patency of the radial artery, assessed by Doppler ultrasound, 7 days after the procedure. Secondarily, the authors assessed the occurrence of bleeding/hematoma at the puncture site during compression, after removal of the dressing and on the 7th day after the procedure.The radial access was selected after the performance of the Allen test and, when needed, the Barbeau test was used for assessment of the palmar arch irrigation.Arterial occlusion was defined as the absence of radial flow, assessed by Doppler, proximal to the puncture site on the 7th day after the procedure. The evaluation with Doppler ultrasound was performed by an experienced physician who was unaware of the type of compression used in each case.The hematoma assessment during compression, removal of the dressing or device, and after 7 days was based on the classification of the EASY (Early Discharge After Transradial Stenting of Coronary Arteries) study:<a class="elsevierStyleCrossRef" href="#bib0020">4</a> type I if < 5cm in diameter; type II if < 10cm diameter; type III if > 10cm, without reaching the elbow; type IV if the hematoma extended beyond the elbow; and type V if there was any hematoma with ischemic injury to the hand.Statistical analysisCategorical variables were shown as absolute numbers and percentages and compared by the Chi-square test and, when indicated, by Fisher's exact test. Continuous variables were described as means and standard deviations, and compared by the Student's t-test. The Statistical Package for Social Sciences (SPSS) program, version 23.0 for Windows was used, and statistical significance was set at p < 0.05.ResultsFrom March 2013 to June 2014, 1,290 procedures were performed, of which 1,150 used the radial approach (89.1%) in three Invasive Cardiology services coordinated by the same medical group. A total of 528 patients (45.9%) met the eligibility criteria and agreed to return for re-evaluation and Doppler ultrasound 1 week after the percutaneous procedure (416 in the compressive dressing group and 112 in the wristband device group), being the focus of this analysis.The mean age of these individuals was 58 ± 9 years, most of whom were males (78.3%). In the wristband device group, there was a higher incidence of patients with ST-elevation myocardial infarction (3.8% vs. 14.2%). Most used non-hydrophilic 6 F sheaths in both cohorts, with no statistical difference between them (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>There was a higher occurrence of bleeding during and after the withdrawal of the sheath in the group using the compressive dressing (13.4% vs. 0; p < 0.001). All hematomas were classified as type I or II according to the EASY classification. Of note, 1 week after the percutaneous procedure there was no bleeding or hematoma formation in the compressive dressing group, whereas in the wristband device group there were eight cases (7.1%) of small local hematoma, none of which required intervention (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Regarding the primary outcome of this analysis, at the end of the first week after the percutaneous procedure, there was no significant difference in radial occlusion rate by Doppler ultrasound in both groups, although numerically a two-fold higher occlusion rate was observed in the group using the wristband device (3.8% vs. 7.1%; p = 0.20). Notably, all the occlusion cases in the group using the dedicated device occurred in patients with late formation of local hematoma.DiscussionThe main finding of this analysis is that hemostasis following procedures using radial approach can be equally obtained with the use of compressive dressings or dedicated compression wristband devices, with no harmful effects on late patency of the approached artery. It is noteworthy that the incidence of bleeding/hematoma in the initial phase of sheath withdrawal is slightly higher with the use of compressive dressings, but without prolonging in-hospital stay and/or generating additional procedures.Maintaining radial patency is important not only for upper limb vascularization but also for the maintenance of access for future percutaneous interventions. Several measures influence the radial artery patency, from technical issues related to puncture and vessel canalization, as well as issues related to the material used (hydrophilic sheaths, dedicated catheters etc.) and adjunctive pharmacology.<a class="elsevierStyleCrossRefs" href="#bib0040">8–10</a> Studies have shown that the routine administration of 5,000 IU of heparin could reduce the rate of radial artery occlusion by up to ten times.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> This measure was used in all patients from both cohorts of this study.Another crucial point in the late maintenance of radial patency is related to sheath withdrawal and the subsequent compression. More recent studies have shown that maintaining some antegrade blood flow during radial hemostasis (patent hemostasis) could help to reduce the occurrence of thrombosis in this access.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Although in theory the use of dedicated devices promotes better control of vascular patency during hemostasis, there is a scarcity of studies evaluating the different types of compression devices and even compression dressings, often used in this service's routine.<a class="elsevierStyleCrossRef" href="#bib0060">12</a> It is noteworthy that in the authors’ experience although there was no statistical difference, numerically the use of hemostatic devices resulted in rates of radial artery occlusion twice as high in the assessment with Doppler ultrasound.Another factor to be considered when deciding on the type of hemostasis to be adopted is related to the occurrence of bleeding complications, including local hematomas. It is important to note that, unlike the femoral artery approach, bleeding events in the radial approach are in general not very significant, with no impact on mortality, but are related to the patient's comfort.<a class="elsevierStyleCrossRefs" href="#bib0035">7,13–15</a> In this analysis, the most frequent occurrence of bleeding and hematoma was found during and right after sheath withdrawal in the group using a compressive dressing. There is no doubt that this is related to the greater difficulty of adjusting the correct level of compression with this type of dressing. However, as also mentioned, the bleeding was small, did not require additional measures to stabilize the patient, and did not result in increased length of hospital stay. The authors did not perform an evaluation of patient comfort and pain in either group, which does not allow for assessing the impact of this complication on the patient's perception regarding the safety and comfort of the procedure.Finally, although this study does not provide a cost-effectiveness analysis, it leads to reflection on the issues of expenses related to percutaneous intervention and the incorporation of new devices into this practice. Although the cost of the compression devices varies per manufacturer and according to the sales agreement with different hospitals, in Brazil these devices cost 20 times more than the conventional compressive dressings with gauze pads (R$ 50.00 vs. R$ 2.50). Considering that, in the period of this evaluation, 112 dedicated devices were used and that the other stages of the percutaneous procedure were similar in both groups, the use of these devices generated an additional expense of R$ 5,600.00, with which the authors could perform compressive dressings in another 2,240 patients undergoing procedures by radial approach.LimitationsThe main limitation of the study is the fact that it was not randomized, which may have introduced bias in the compared populations. The non-availability of procedure variables (re-use of radial approach, number of puncture attempts, duration of procedure) may have influenced the results. Also, the lack of application of a questionnaire on patient comfort during the sheath withdrawal period prevents comparison of the compression types in this regard.ConclusionsThe use of conventional compressive dressings to perform hemostasis after percutaneous procedures through the radial approach showed to be equivalent to the use of wristband hemostatic devices in relation to the late patency of the access artery, although their use was associated with slightly higher rates of bleeding. Hemorrhagic complications by radial access were relatively rare and minor, with no impact on the short-term evolution of both cohorts.Funding sourcesNone.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres844872" "titulo" => "ABSTRACT" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec839805" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres844871" "titulo" => "RESUMO" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec839804" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population and study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Radial puncture" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Radial compression technique after sheath removal" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Wristband device" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Compressive dressing" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Study objectives and definitions" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding sources" ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-07-07" "fechaAceptado" => "2015-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec839805" "palabras" => array:4 [ 0 => "Radial artery" 1 => "Cardiac catheterization" 2 => "Angioplasty" 3 => "Doppler ultrasound" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec839804" "palabras" => array:4 [ 0 => "Artéria radial" 1 => "Cateterismo cardíaco" 2 => "Angioplastia" 3 => "Ultrassonografia Doppler" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "ABSTRACT" "resumen" => "BackgroundWristband devices used in the compression of the radial puncture site add cost to the procedure and have not been adequately compared with conventional compressive dressings. This study evaluated the effectiveness and safety of both forms of hemostasis in patients undergoing coronary angiography and/or percutaneous coronary intervention in daily practice. MethodsA prospective, multicenter, nonrandomized study, which included consecutive patients who underwent procedures through radial access. The type of compression was at the interventionist's discretion and the availability of wristband devices. The main objective was to compare the patency of the radial artery on the 7th day after the procedure, measured by Doppler. Secondarily, the authors evaluated the occurrence of bleeding/hematoma at the puncture site during compression, after removal of the device and on the 7th day after the procedure. ResultsThis study evaluated 528 patients, 416 using conventional compressive dressings and 112 using wristband devices. When the sheath was removed and soon after its removal, a higher incidence of bleeding in the conventional compressive dressings group was observed (13.4% vs. 0%; p < 0.001). All bleeding events were small (type I or type II) and did not require further actions. At 7 days, there were only small hematomas at the puncture site in 7.1% of cases that used the wristband device. There was no difference in the patency rates of the radial artery (3.8% vs. 7.1%; p = 0.20). ConclusionsThe use of wristband devices for radial artery hemostasis did not result in higher rates of late arterial patency when compared to conventional compressive dressings." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "RESUMO" "resumen" => "IntroduçãoDispositivos dedicados à compressão do sítio de punção radial adicionam custo ao procedimento e não foram adequadamente comparados aos curativos compressivos. Avaliamos a efetividade e a segurança de ambas as formas de hemostasia em pacientes submetidos à cinecoronariografia e/ou intervenção coronária percutânea na prática diária. MétodosEstudo prospectivo, multicêntrico e não randomizado, que incluiu pacientes consecutivamente submetidos a procedimentos por via radial. A modalidade de compressão ficou a critério do operador e da disponibilidade das pulseiras hemostáticas. O objetivo primário foi a comparação da patência da artéria radial no sétimo dia pós-procedimento, aferida por meio do Doppler. Secundariamente, avaliamos a ocorrência de hemorragia/hematoma no sítio de punção durante a compressão, após a retirada do dispositivo e no sétimo dia pós-procedimento. ResultadosForam avaliados 528 pacientes, 416 que usaram o curativo compressivo e 112 que usaram a pulseira hemostática. Na fase da retirada do introdutor e logo após sua remoção, notou-se uma incidência maior de sangramento no grupo curativo compressivo (13,4% vs. 0%; p < 0,001). Todos os sangramentos foram pequenos (tipo I ou II) e não necessitaram medidas adicionais. Aos 7 dias, observou-se apenas formação de pequenos hematomas no sítio da punção em 7,1% dos casos que utilizaram a pulseira de compressão. Não houve diferença nas taxas de patência da artéria radial (3,8% vs. 7,1%; p = 0,20). ConclusõesO uso de pulseira dedicada à hemostasia da artéria radial não resultou em maiores taxas de patência arterial tardia quando comparada ao curativo compressivo simples." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusões" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Peer review under the responsibility of Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1307 "Ancho" => 1744 "Tamanyo" => 209715 ] ] "descripcion" => array:1 [ "en" => "Placement of the hemostatic device: the device is placed approximately 1cm above the puncture site with balloon inflation using 15mL of air (A). The sheath is submitted to traction and withdrawn (B). Deflation starts at each 3mL, while observing the onset of bleeding (C). At this time, further inflation is performed with 3mL of air and the patient's limb is maintained at rest for 1 hour (D)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1309 "Ancho" => 1744 "Tamanyo" => 221915 ] ] "descripcion" => array:1 [ "en" => "Placement of the conventional compressive dressing: externalization of the sheath is started after cuff inflation > 10mmHg of the patient's systolic blood pressure (A). Close to the sheath externalization, the dressing is positioned 1cm above the puncture site, applying manual pressure (B). Next, the first compression tape is placed (C), and then the dressing is completed in an “X” (D)." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "NSTE-ACS: non-ST-elevation acute coronary syndrome; STEMI: ST-elevation myocardial infarction." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Compressive dressing group (n = 416) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wristband device group (n = 112) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">59 ± 22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">57 ± 13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">321 (77.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">89 (79.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">328 (78.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">88 (78.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">> 0.99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">144 (34.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">64 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">152 (36.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">48 (42.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical presentation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Stable angina/silent ischemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">304 (73.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">80 (71.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NSTE-ACS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">96 (23.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">16 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">STEMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">16 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">16 (14.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Percutaneous coronary intervention, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">184 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">72 (64.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sheath type, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">392 (94.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">104 (92.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">24 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adjunct medication, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heparin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">192 (46.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">64 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acetylsalicylic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">128 (30.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">24 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dual antiplatelet therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">72 (64.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glycoprotein IIb/IIIa inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">16 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1426916.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Basal characteristics of the studied population." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Events \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Compressive dressing group (n = 416) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wristband device group (n = 112) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In-hospital events, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bleeding during decompression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">56 (13.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">48 (11.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Grade II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bleeding after hemostasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (1.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Events at 1 week follow-up, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radial artery occlusion by Doppler ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">16 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">New hematoma at the puncture site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">8 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="center" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1426917.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Vascular and bleeding events." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "2481-9" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. 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Comparison of conventional compressive dressings vs. wristband devices after catheterization by radial approach

Comparação do curativo compressivo vs. pulseira hemostática após cateterização por via radial

Said Assaf Netoa,

Corresponding author

said.assaf@gmail.com

Corresponding author: Rua João Gurgel, 1.477, apto. 51 − Carmo − CEP: 14801-405 − Araraquara (SP), Brazil.

, João Orávio de Freitas Jr.a, Sérgio Luis Bertib, J. Ribamar Costa Jr.c, Jorge Augusto L. Zbeidd

a Hospital Carlos Fernando Malzoni, Matão, SP, Brazil

b Santa Casa de São Carlos, São Carlos, SP, Brazil

c Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil

d Hospital São Paulo, Araraquara, SP, Brazil

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            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Coronary angiography on the left &#40;<span class="elsevierStyleBold">A</span>&#41;&#46; Rotational atherectomy to the left anterior descending &#40;<span class="elsevierStyleBold">B</span>&#41; and left circumflex &#40;<span class="elsevierStyleBold">C</span>&#41; arteries&#46; Stent implantation in the left anterior descending artery &#40;<span class="elsevierStyleBold">D1</span> and <span class="elsevierStyleBold">D2</span>&#41;&#44; in the left main coronary artery&#44; and in left circumflex &#40;<span class="elsevierStyleBold">E</span>&#41;&#46; Angiographic result &#40;<span class="elsevierStyleBold">F</span>&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Placement of the conventional compressive dressing&#58; externalization of the sheath is started after cuff inflation &#62; 10<span class="elsevierStyleHsp" style=""></span>mmHg of the patient&#39;s systolic blood pressure &#40;<span class="elsevierStyleBold">A</span>&#41;&#46; Close to the sheath externalization&#44; the dressing is positioned 1<span class="elsevierStyleHsp" style=""></span>cm above the puncture site&#44; applying manual pressure &#40;<span class="elsevierStyleBold">B</span>&#41;&#46; Next&#44; the first compression tape is placed &#40;<span class="elsevierStyleBold">C</span>&#41;&#44; and then the dressing is completed in an &#8220;X&#8221; &#40;<span class="elsevierStyleBold">D</span>&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The use of radial access has become increasingly common in the contemporary scenario of percutaneous coronary intervention &#40;PCI&#41;&#44; given its superiority over the femoral access regarding the reduction of mortality&#44; especially in acute coronary syndrome&#44; as shown by several clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;4</span></a> Additionally&#44; this type of access is associated with lower rates of vascular complications&#47;bleeding and promotes greater comfort for the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Aiming to make local hemostasis more practical after the use of radial approach&#44; devices dedicated to puncture site compression have been recently developed&#46; Although practical and effective&#44; these devices add cost to the procedure and have not been adequately compared to the use of conventional compressive dressings&#44; universally available and at a relatively low cost&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The present study aimed to compare the effectiveness and safety of both forms of hemostasis of the radial puncture site in patients undergoing coronary angiography and&#47;or PCI in daily practice&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Population and study design</span><p id="par0020" class="elsevierStylePara elsevierViewall">This is a prospective&#44; multicenter&#44; nonrandomized study including consecutive patients undergoing procedures through radial access&#46; Patients older than 18 years undergoing elective diagnostic catheterization&#44; elective PCI or cardiac catheterization&#44; followed by percutaneous intervention &#40;<span class="elsevierStyleItalic">ad hoc</span>&#41;&#44; were included&#46; The authors only excluded those patients with prior coronary artery bypass graft surgery and those who had cardiogenic shock at the time of examination&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of dedicated wristband devices for hemostatic compression or compressive dressings was at the interventionist&#39;s discretion and the service&#39;s availability during the period of registry inclusion&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Radial puncture</span><p id="par0030" class="elsevierStylePara elsevierViewall">After the radial puncture and passage of the sheath&#44; a solution containing 5&#44;000 IU of unfractionated heparin&#44; 40<span class="elsevierStyleHsp" style=""></span>mg of isosorbide mononitrate&#44; and 2<span class="elsevierStyleHsp" style=""></span>mL of lidocaine was infused into the radial artery&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In cases of elective or <span class="elsevierStyleItalic">ad hoc</span> PCI&#44; an additional dose of unfractionated heparin was administered&#44; up to 100 IU&#47;kg&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Radial compression technique after sheath removal</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Wristband device</span><p id="par0040" class="elsevierStylePara elsevierViewall">Two models of transradial compression wristband devices were used&#58; the TR Band<span class="elsevierStyleSup">&#174;</span> compressive device &#40;Terumo Medical&#44; Tokyo&#44; Japan&#41; or the RadiStop<span class="elsevierStyleSup">&#174;</span> device &#40;St&#46; Jude Medical&#44; St&#46; Paul&#44; USA&#41;&#46; According to the manufacturer&#39;s recommendations&#44; the authors positioned the compression point approximately 1<span class="elsevierStyleHsp" style=""></span>cm above the puncture site with balloon inflation using 15<span class="elsevierStyleHsp" style=""></span>mL of air&#44; after which the sheath was submitted to traction and removed&#44; and then deflation was started at each 3<span class="elsevierStyleHsp" style=""></span>mL&#44; observing whether or not bleeding occurred&#46; If blood extravasation was observed&#44; a new insufflation was performed with 3<span class="elsevierStyleHsp" style=""></span>mL of air and the patient kept the limb at rest for 1 hour&#46; After this period&#44; decompression was performed&#44; with 3<span class="elsevierStyleHsp" style=""></span>mL of air being withdrawn every 30<span class="elsevierStyleHsp" style=""></span>minutes until complete deflation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Subsequently&#44; a non-compressive dressing was maintained&#44; followed by the recommendation to rest and return in 7 days&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Compressive dressing</span><p id="par0045" class="elsevierStylePara elsevierViewall">Hemostasis was initiated with the inflation of the sphygmomanometer cuff in the arm&#44; at 200<span class="elsevierStyleHsp" style=""></span>mmHg&#44; followed by removal of the sheath&#46; Then&#44; a gauze pad and four strips of micropore tape &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; in the shape of an &#8220;X&#8221;&#44; were positioned&#46; Over this first dressing&#44; other gauze pads&#44; previously folded into quadrangular shapes&#44; were positioned and the compression dressing was performed with adhesive tape&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">After that&#44; the cuff was deflated and&#44; if bleeding or distal cyanosis was observed&#44; the dressing was remade&#46; Similarly to compression using the wristband device&#44; the patient rested for 1 hour with the compressive dressing&#46; After this period&#44; the compressive tape was removed and a simple dressing with micropore tape was maintained&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">At the discharge&#44; the patient received the same care and recommendations given to those who received compression wristband devices&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Study objectives and definitions</span><p id="par0060" class="elsevierStylePara elsevierViewall">The primary objective of this analysis was to compare the patency of the radial artery&#44; assessed by Doppler ultrasound&#44; 7 days after the procedure&#46; Secondarily&#44; the authors assessed the occurrence of bleeding&#47;hematoma at the puncture site during compression&#44; after removal of the dressing and on the 7<span class="elsevierStyleSup">th</span> day after the procedure&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The radial access was selected after the performance of the Allen test and&#44; when needed&#44; the Barbeau test was used for assessment of the palmar arch irrigation&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Arterial occlusion was defined as the absence of radial flow&#44; assessed by Doppler&#44; proximal to the puncture site on the 7<span class="elsevierStyleSup">th</span> day after the procedure&#46; The evaluation with Doppler ultrasound was performed by an experienced physician who was unaware of the type of compression used in each case&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The hematoma assessment during compression&#44; removal of the dressing or device&#44; and after 7 days was based on the classification of the EASY &#40;Early Discharge After Transradial Stenting of Coronary Arteries&#41; study&#58;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> type I if &#60; 5<span class="elsevierStyleHsp" style=""></span>cm in diameter&#59; type II if &#60; 10<span class="elsevierStyleHsp" style=""></span>cm diameter&#59; type III if &#62; 10<span class="elsevierStyleHsp" style=""></span>cm&#44; without reaching the elbow&#59; type IV if the hematoma extended beyond the elbow&#59; and type V if there was any hematoma with ischemic injury to the hand&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0080" class="elsevierStylePara elsevierViewall">Categorical variables were shown as absolute numbers and percentages and compared by the Chi-square test and&#44; when indicated&#44; by Fisher&#39;s exact test&#46; Continuous variables were described as means and standard deviations&#44; and compared by the Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; The Statistical Package for Social Sciences &#40;SPSS&#41; program&#44; version 23&#46;0 for Windows was used&#44; and statistical significance was set at <span class="elsevierStyleItalic">p</span> &#60; 0&#46;05&#46;</p></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">From March 2013 to June 2014&#44; 1&#44;290 procedures were performed&#44; of which 1&#44;150 used the radial approach &#40;89&#46;1&#37;&#41; in three Invasive Cardiology services coordinated by the same medical group&#46; A total of 528 patients &#40;45&#46;9&#37;&#41; met the eligibility criteria and agreed to return for re-evaluation and Doppler ultrasound 1 week after the percutaneous procedure &#40;416 in the compressive dressing group and 112 in the wristband device group&#41;&#44; being the focus of this analysis&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean age of these individuals was 58 &#177; 9 years&#44; most of whom were males &#40;78&#46;3&#37;&#41;&#46; In the wristband device group&#44; there was a higher incidence of patients with ST-elevation myocardial infarction &#40;3&#46;8&#37; vs&#46; 14&#46;2&#37;&#41;&#46; Most used non-hydrophilic 6 F sheaths in both cohorts&#44; with no statistical difference between them &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">There was a higher occurrence of bleeding during and after the withdrawal of the sheath in the group using the compressive dressing &#40;13&#46;4&#37; vs&#46; 0&#59; <span class="elsevierStyleItalic">p</span> &#60; 0&#46;001&#41;&#46; All hematomas were classified as type I or II according to the EASY classification&#46; Of note&#44; 1 week after the percutaneous procedure there was no bleeding or hematoma formation in the compressive dressing group&#44; whereas in the wristband device group there were eight cases &#40;7&#46;1&#37;&#41; of small local hematoma&#44; none of which required intervention &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the primary outcome of this analysis&#44; at the end of the first week after the percutaneous procedure&#44; there was no significant difference in radial occlusion rate by Doppler ultrasound in both groups&#44; although numerically a two-fold higher occlusion rate was observed in the group using the wristband device &#40;3&#46;8&#37; vs&#46; 7&#46;1&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;20&#41;&#46; Notably&#44; all the occlusion cases in the group using the dedicated device occurred in patients with late formation of local hematoma&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The main finding of this analysis is that hemostasis following procedures using radial approach can be equally obtained with the use of compressive dressings or dedicated compression wristband devices&#44; with no harmful effects on late patency of the approached artery&#46; It is noteworthy that the incidence of bleeding&#47;hematoma in the initial phase of sheath withdrawal is slightly higher with the use of compressive dressings&#44; but without prolonging in-hospital stay and&#47;or generating additional procedures&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Maintaining radial patency is important not only for upper limb vascularization but also for the maintenance of access for future percutaneous interventions&#46; Several measures influence the radial artery patency&#44; from technical issues related to puncture and vessel canalization&#44; as well as issues related to the material used &#40;hydrophilic sheaths&#44; dedicated catheters etc&#46;&#41; and adjunctive pharmacology&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> Studies have shown that the routine administration of 5&#44;000 IU of heparin could reduce the rate of radial artery occlusion by up to ten times&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This measure was used in all patients from both cohorts of this study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Another crucial point in the late maintenance of radial patency is related to sheath withdrawal and the subsequent compression&#46; More recent studies have shown that maintaining some antegrade blood flow during radial hemostasis &#40;patent hemostasis&#41; could help to reduce the occurrence of thrombosis in this access&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Although in theory the use of dedicated devices promotes better control of vascular patency during hemostasis&#44; there is a scarcity of studies evaluating the different types of compression devices and even compression dressings&#44; often used in this service&#39;s routine&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> It is noteworthy that in the authors&#8217; experience although there was no statistical difference&#44; numerically the use of hemostatic devices resulted in rates of radial artery occlusion twice as high in the assessment with Doppler ultrasound&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Another factor to be considered when deciding on the type of hemostasis to be adopted is related to the occurrence of bleeding complications&#44; including local hematomas&#46; It is important to note that&#44; unlike the femoral artery approach&#44; bleeding events in the radial approach are in general not very significant&#44; with no impact on mortality&#44; but are related to the patient&#39;s comfort&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;13&#8211;15</span></a> In this analysis&#44; the most frequent occurrence of bleeding and hematoma was found during and right after sheath withdrawal in the group using a compressive dressing&#46; There is no doubt that this is related to the greater difficulty of adjusting the correct level of compression with this type of dressing&#46; However&#44; as also mentioned&#44; the bleeding was small&#44; did not require additional measures to stabilize the patient&#44; and did not result in increased length of hospital stay&#46; The authors did not perform an evaluation of patient comfort and pain in either group&#44; which does not allow for assessing the impact of this complication on the patient&#39;s perception regarding the safety and comfort of the procedure&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Finally&#44; although this study does not provide a cost-effectiveness analysis&#44; it leads to reflection on the issues of expenses related to percutaneous intervention and the incorporation of new devices into this practice&#46; Although the cost of the compression devices varies per manufacturer and according to the sales agreement with different hospitals&#44; in Brazil these devices cost 20 times more than the conventional compressive dressings with gauze pads &#40;R&#36; 50&#46;00 vs&#46; R&#36; 2&#46;50&#41;&#46; Considering that&#44; in the period of this evaluation&#44; 112 dedicated devices were used and that the other stages of the percutaneous procedure were similar in both groups&#44; the use of these devices generated an additional expense of R&#36; 5&#44;600&#46;00&#44; with which the authors could perform compressive dressings in another 2&#44;240 patients undergoing procedures by radial approach&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Limitations</span><p id="par0130" class="elsevierStylePara elsevierViewall">The main limitation of the study is the fact that it was not randomized&#44; which may have introduced bias in the compared populations&#46; The non-availability of procedure variables &#40;re-use of radial approach&#44; number of puncture attempts&#44; duration of procedure&#41; may have influenced the results&#46; Also&#44; the lack of application of a questionnaire on patient comfort during the sheath withdrawal period prevents comparison of the compression types in this regard&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusions</span><p id="par0135" class="elsevierStylePara elsevierViewall">The use of conventional compressive dressings to perform hemostasis after percutaneous procedures through the radial approach showed to be equivalent to the use of wristband hemostatic devices in relation to the late patency of the access artery&#44; although their use was associated with slightly higher rates of bleeding&#46; Hemorrhagic complications by radial access were relatively rare and minor&#44; with no impact on the short-term evolution of both cohorts&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding sources</span><p id="par0140" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicts of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "titulo" => "ABSTRACT"
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              "identificador" => "abst0005"
              "titulo" => "Background"
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              "identificador" => "abst0015"
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          "titulo" => "Keywords"
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          "titulo" => "RESUMO"
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            0 => array:2 [
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              "titulo" => "Introdu&#231;&#227;o"
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            1 => array:2 [
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              "titulo" => "M&#233;todos"
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            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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              "titulo" => "Conclus&#245;es"
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          "titulo" => "Palavras-chave"
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          "titulo" => "Methods"
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              "identificador" => "sec0015"
              "titulo" => "Population and study design"
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              "identificador" => "sec0020"
              "titulo" => "Radial puncture"
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              "identificador" => "sec0025"
              "titulo" => "Radial compression technique after sheath removal"
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                  "identificador" => "sec0030"
                  "titulo" => "Wristband device"
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                  "titulo" => "Study objectives and definitions"
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                  "titulo" => "Statistical analysis"
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          "titulo" => "Discussion"
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          "titulo" => "Limitations"
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          "titulo" => "Conclusions"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "fechaRecibido" => "2015-07-07"
    "fechaAceptado" => "2015-10-10"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:4 [
            0 => "Radial artery"
            1 => "Cardiac catheterization"
            2 => "Angioplasty"
            3 => "Doppler ultrasound"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
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          "palabras" => array:4 [
            0 => "Art&#233;ria radial"
            1 => "Cateterismo card&#237;aco"
            2 => "Angioplastia"
            3 => "Ultrassonografia Doppler"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "ABSTRACT"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Wristband devices used in the compression of the radial puncture site add cost to the procedure and have not been adequately compared with conventional compressive dressings&#46; This study evaluated the effectiveness and safety of both forms of hemostasis in patients undergoing coronary angiography and&#47;or percutaneous coronary intervention in daily practice&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; multicenter&#44; nonrandomized study&#44; which included consecutive patients who underwent procedures through radial access&#46; The type of compression was at the interventionist&#39;s discretion and the availability of wristband devices&#46; The main objective was to compare the patency of the radial artery on the 7<span class="elsevierStyleSup">th</span> day after the procedure&#44; measured by Doppler&#46; Secondarily&#44; the authors evaluated the occurrence of bleeding&#47;hematoma at the puncture site during compression&#44; after removal of the device and on the 7<span class="elsevierStyleSup">th</span> day after the procedure&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">This study evaluated 528 patients&#44; 416 using conventional compressive dressings and 112 using wristband devices&#46; When the sheath was removed and soon after its removal&#44; a higher incidence of bleeding in the conventional compressive dressings group was observed &#40;13&#46;4&#37; vs&#46; 0&#37;&#59; <span class="elsevierStyleItalic">p</span> &#60; 0&#46;001&#41;&#46; All bleeding events were small &#40;type I or type II&#41; and did not require further actions&#46; At 7 days&#44; there were only small hematomas at the puncture site in 7&#46;1&#37; of cases that used the wristband device&#46; There was no difference in the patency rates of the radial artery &#40;3&#46;8&#37; vs&#46; 7&#46;1&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;20&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The use of wristband devices for radial artery hemostasis did not result in higher rates of late arterial patency when compared to conventional compressive dressings&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
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            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Dispositivos dedicados &#224; compress&#227;o do s&#237;tio de pun&#231;&#227;o radial adicionam custo ao procedimento e n&#227;o foram adequadamente comparados aos curativos compressivos&#46; Avaliamos a efetividade e a seguran&#231;a de ambas as formas de hemostasia em pacientes submetidos &#224; cinecoronariografia e&#47;ou interven&#231;&#227;o coron&#225;ria percut&#226;nea na pr&#225;tica di&#225;ria&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo&#44; multic&#234;ntrico e n&#227;o randomizado&#44; que incluiu pacientes consecutivamente submetidos a procedimentos por via radial&#46; A modalidade de compress&#227;o ficou a crit&#233;rio do operador e da disponibilidade das pulseiras hemost&#225;ticas&#46; O objetivo prim&#225;rio foi a compara&#231;&#227;o da pat&#234;ncia da art&#233;ria radial no s&#233;timo dia p&#243;s-procedimento&#44; aferida por meio do Doppler&#46; Secundariamente&#44; avaliamos a ocorr&#234;ncia de hemorragia&#47;hematoma no s&#237;tio de pun&#231;&#227;o durante a compress&#227;o&#44; ap&#243;s a retirada do dispositivo e no s&#233;timo dia p&#243;s-procedimento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Foram avaliados 528 pacientes&#44; 416 que usaram o curativo compressivo e 112 que usaram a pulseira hemost&#225;tica&#46; Na fase da retirada do introdutor e logo ap&#243;s sua remo&#231;&#227;o&#44; notou-se uma incid&#234;ncia maior de sangramento no grupo curativo compressivo &#40;13&#44;4&#37; vs&#46; 0&#37;&#59; <span class="elsevierStyleItalic">p</span> &#60; 0&#44;001&#41;&#46; Todos os sangramentos foram pequenos &#40;tipo I ou II&#41; e n&#227;o necessitaram medidas adicionais&#46; Aos 7 dias&#44; observou-se apenas forma&#231;&#227;o de pequenos hematomas no s&#237;tio da pun&#231;&#227;o em 7&#44;1&#37; dos casos que utilizaram a pulseira de compress&#227;o&#46; N&#227;o houve diferen&#231;a nas taxas de pat&#234;ncia da art&#233;ria radial &#40;3&#44;8&#37; vs&#46; 7&#44;1&#37;&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#44;20&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">O uso de pulseira dedicada &#224; hemostasia da art&#233;ria radial n&#227;o resultou em maiores taxas de pat&#234;ncia arterial tardia quando comparada ao curativo compressivo simples&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer review under the responsibility of Sociedade Brasileira de Hemodin&#226;mica e Cardiologia Intervencionista&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Placement of the hemostatic device&#58; the device is placed approximately 1<span class="elsevierStyleHsp" style=""></span>cm above the puncture site with balloon inflation using 15<span class="elsevierStyleHsp" style=""></span>mL of air &#40;<span class="elsevierStyleBold">A</span>&#41;&#46; The sheath is submitted to traction and withdrawn &#40;<span class="elsevierStyleBold">B</span>&#41;&#46; Deflation starts at each 3<span class="elsevierStyleHsp" style=""></span>mL&#44; while observing the onset of bleeding &#40;<span class="elsevierStyleBold">C</span>&#41;&#46; At this time&#44; further inflation is performed with 3<span class="elsevierStyleHsp" style=""></span>mL of air and the patient&#39;s limb is maintained at rest for 1 hour &#40;<span class="elsevierStyleBold">D</span>&#41;&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Placement of the conventional compressive dressing&#58; externalization of the sheath is started after cuff inflation &#62; 10<span class="elsevierStyleHsp" style=""></span>mmHg of the patient&#39;s systolic blood pressure &#40;<span class="elsevierStyleBold">A</span>&#41;&#46; Close to the sheath externalization&#44; the dressing is positioned 1<span class="elsevierStyleHsp" style=""></span>cm above the puncture site&#44; applying manual pressure &#40;<span class="elsevierStyleBold">B</span>&#41;&#46; Next&#44; the first compression tape is placed &#40;<span class="elsevierStyleBold">C</span>&#41;&#44; and then the dressing is completed in an &#8220;X&#8221; &#40;<span class="elsevierStyleBold">D</span>&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">NSTE-ACS&#58; non-ST-elevation acute coronary syndrome&#59; STEMI&#58; ST-elevation myocardial infarction&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Compressive dressing group<br>&#40;n &#61; 416&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wristband device group<br>&#40;n &#61; 112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">59 &#177; 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">57 &#177; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male gender&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">321 &#40;77&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">89 &#40;79&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial hypertension&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">328 &#40;78&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">88 &#40;78&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">&#62; 0&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">144 &#40;34&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">64 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Smoking&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">152 &#40;36&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">48 &#40;42&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical presentation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stable angina&#47;silent ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">304 &#40;73&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">80 &#40;71&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NSTE-ACS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">96 &#40;23&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">16 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STEMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">16 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">16 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">184 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">72 &#40;64&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">&#60; 0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">392 &#40;94&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">104 &#40;92&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5 F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">24 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">8 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heparin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">192 &#40;46&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">64 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Acetylsalicylic acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">128 &#40;30&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">24 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dual antiplatelet therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">72 &#40;64&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Glycoprotein IIb&#47;IIIa inhibitors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">16 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">8 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&#46;22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="center" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  "comentario" => "2481-9"
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                      "titulo" => "Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome&#58; the RIFLE-STEACS &#40;Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome&#41; Study"
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                        0 => array:2 [
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                          "autores" => array:6 [
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                            2 => "A&#46; Sciahbasi"
                            3 => "L&#46; Politi"
                            4 => "S&#46; Rigattieri"
                            5 => "G&#46; Pendenza"
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                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2012"
                        "volumen" => "60"
                        "numero" => "24"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23194943"
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                  "comentario" => "905-16"
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                      "titulo" => "Radial access in patients with ST-segment elevation myocardial infarction undergoing primary angioplasty in acute myocardial infarction&#58; the HORIZONS-AMI trial"
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                        0 => array:3 [
                          "colaboracion" => "HORIZONS-AMI Trial Investigators"
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                      "titulo" => "Transradial approach for coronary angioplasty in the setting of acute myocardial infarction&#58; a dual-center registry"
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                          "etal" => true
                          "autores" => array:6 [
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                            5 => "D&#46; Scheinert"
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                      "Revista" => array:4 [
                        "tituloSerie" => "Catheter Cardiovasc Interv&#46;"
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Article information

ISSN: 22141235
Original language: English

DOI:10.1016/j.rbciev.2017.02.014

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Year/Month	Html	Pdf	Total

2024 October	40	8	48
2024 September	86	13	99
2024 August	56	7	63
2024 July	60	14	74
2024 June	49	12	61
2024 May	35	12	47
2024 April	46	9	55
2024 March	68	11	79
2024 February	96	6	102
2024 January	66	4	70
2023 December	71	13	84
2023 November	101	16	117
2023 October	106	14	120
2023 September	62	6	68
2023 August	50	12	62
2023 July	53	7	60
2023 June	80	4	84
2023 May	83	6	89
2023 April	93	3	96
2023 March	97	3	100
2023 February	38	7	45
2023 January	42	3	45
2022 December	80	3	83
2022 November	44	5	49
2022 October	42	8	50
2022 September	83	14	97
2022 August	81	18	99
2022 July	48	10	58
2022 June	60	5	65
2022 May	45	13	58
2022 April	34	7	41
2022 March	63	12	75
2022 February	43	8	51
2022 January	76	12	88
2021 December	75	5	80
2021 November	65	5	70
2021 October	79	10	89
2021 September	66	13	79
2021 August	59	7	66
2021 July	26	5	31
2021 June	27	7	34
2021 May	28	6	34
2021 April	58	35	93
2021 March	33	9	42
2021 February	23	9	32
2021 January	37	8	45
2020 December	44	12	56
2020 November	29	5	34
2020 October	29	5	34
2020 September	21	11	32
2020 August	26	5	31
2020 July	17	9	26
2020 June	12	2	14
2020 May	20	5	25
2020 April	7	7	14
2020 March	7	4	11
2020 February	21	6	27
2020 January	11	8	19
2019 December	32	13	45
2019 November	16	5	21
2019 October	11	1	12
2019 September	13	1	14
2019 August	4	3	7
2019 July	4	5	9
2019 June	19	17	36
2019 May	22	23	45
2018 October	1	0	1
2018 September	10	1	11
2018 August	46	12	58
2018 July	32	9	41
2018 June	61	8	69
2018 May	49	9	58
2018 April	67	9	76
2018 March	123	9	132
2018 February	42	14	56
2018 January	28	6	34
2017 December	26	10	36
2017 November	32	24	56
2017 October	43	22	65
2017 September	40	19	59
2017 August	24	23	47
2017 July	36	18	54
2017 June	57	18	75
2017 May	43	13	56
2017 April	42	21	63
2017 March	18	14	32

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