Two hour ambulation after coronary angioplasty and stenting with 6硓 guiding catheters and low dose heparin

doi:10.1136/hrt.81.1.53

Heart 1999;81:53-56; doi:10.1136/hrt.81.1.53

Heart 1999;81:53-56 ( January )

Two hour ambulation after coronary angioplasty and stenting with 6 F guiding catheters and low dose heparin

K T Koch,^a J J Piek,^a R J de Winter,^a K Mulder,^a C E Schotborgh,^a J G P Tijssen,^b K I Lie^a

^a Department of Cardiology, B2-136, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands, ^b Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam

Correspondence to: Dr Koch.

Accepted for publication 14 September 1998

Objective $---$ To evaluate the feasibility and safety of ambulation of patients two hours after elective coronary angioplasty or stenting,orboth.
Methods $---$ Coronary angioplasty and stenting were performed using 6 F guiding catheters by the femoral approach and a standard dose ofheparin 5000 IU. There were no angiographic exclusion criteriaexcept for planned atherectomy. Patients given oral anticoagulantsor heparin were not eligible. All patients were given aspirin.Patients who underwent stent implantation also received ticlopidine250 mg daily. The arterial sheath was removed immediately afterthe procedure. Haemostasis was achieved by manual compressionand maintained with an inguinal compression bandage. Early ambulationwas attempted after two hours of supine bed rest following removalof thebandage.
Main outcome measures $---$ The incidence of bleeding at or during ambulation requiring compression and additional bed rest, and puncture site complicationsdocumented 48 hours after theprocedure.
Results $---$ 300 of 359 consecutive eligible patients were included for two hour ambulation. Stent implantation was performed in 32% ofthe procedures. The mean (SD) time to haemostasis was 9.6 (3.2)minutes. Bleeding at ambulation occurred in five patients (1.7%),and nine patients (3.0%) reached the secondary end point of haematoma> 5 × 5 cm at 48 hour follow up. All were treated conservativelywithout further sequelae. There was no late bleeding or vascularcomplications.
Conclusion $---$ Ambulation two hours after elective balloon angioplasty or stent implantation with 6 F guiding catheters by the femoral routeand low dose heparin is feasible and safe, with a low incidenceof puncture site complications. This early ambulation protocolfacilitates a short hospitalstay.

Keywords: angioplasty; heparin; ambulation; patient management

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