Contemporary transradial access practices: Results of the second international survey.

OBJECTIVES: To gain insight into current practice of transradial angiography and intervention in the United States and around the world. BACKGROUND: Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators. METHODS: We used an internet-based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent-level comparisons were made with the prior survey to assess for temporal changes in practice. RESULTS: Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts. CONCLUSIONS: There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.

Vascular closure devices: the second decade.

Vascular closure devices (VCDs) introduce a novel means for improving patient comfort and accelerating ambulation after invasive cardiovascular procedures performed via femoral arterial access. Vascular closure devices have provided simple, rapid, and reliable hemostasis in a variety of clinical settings. Despite more than a decade of development, however, VCD utilization has neither been routine in the U.S. nor around the world. Their limited adoption reflects concerns of higher costs for cardiac procedures and a lack of data confirming a significant reduction in vascular complications compared with manual compression. Recent data, however, suggest that VCD are improving, complication rates associated with their use may be decreasing, and their utilization may improve the process of care after femoral artery access. Challenges in the second decade of VCD experience will include performing definitive randomized trials, evaluating outcomes in higher-risk patients, and developing more ideal closure devices.

Applications of FloSeal in nephron-sparing surgery.

Hemostasis can be a challenging problem to control laparoscopically. We advocate the use of FloSeal Matrix. FloSeal can be used in a variety of open and laparoscopic procedures, including laparoscopic or open partial nephrectomy. FloSeal was highly effective in stopping bleeding in a bloody surgical field.

Coagulorama especial (CE): evaluación de la hemostasia en el laboratorio / Special coagulogram (CE): evaluation of the hemostasis in laboratory

MARCO TEORICO: En la última década en el Hospital ABC hemos observado un aumento en el número de pacientes que requieren terapia intensiva, se ha incrementado el número de pacientes con padecimientos oncológicos. Adicionalmente se ha iniciado la trombolisis del infarto agudo del miocardio y se ha implementado un programa de cirugía cardiovascular. En consecuencia el laboratorio ha tenido que ampliar sus estrategias para el estudio de los trastornos de la hemostasia. OBJETIVO: Conocer la frecuencia con que se indican las pruebas especiales de la coagulación en el laboratorio clínico del Hospital ABC así como las alteraciones más frecuentes encontradas. TIPO DE ESTUDIO: Investigación clínica, retrosp[ectiva, observacional, comparativa de un período anual de pacientes a quienes se les realizaron estudios especiales de la coagulación en forma integrada como un coagulogama especial (CE). RESULTADOS: Se estudiaron 67 pacientes a los que se les realizaron un total de 98 (CE). La mayoría de los estudios se realizaron en pacientes ambulatorios (63.2 por ciento). A 62 pacientes se les solicitó 1 solo estudio (Grupo 1), a 36 se les indicaron 2 o más (Grupo 2). En el primer grupo la alteración más frecuente fue hipercoagulabilidad (p<0.001). En el segundo grupo se encontró que la alteración más frecuente fue la deficiencia de factores (p<0.025). un 27 por ciento de los estudios fueron completamente normales. CONCLUSIONES: El coagulograma especial es un "perfil" que además de ser costoso para el paciente, resulta muy laborioso para el personal de laboratorio. El haber encontrado que un 27 por iento de los estudios fueron completamente normales nos obliga a insistir que esta batería de estudios solo se debe indicar cuando el coagulograma de rutina o el estado clínico del paciente hagan sospechar alteraciones específicas tales como la hipercoagulabilidad, la presencia de anticoagulante o la deficiencia de factores. Es necesario oncluir un resumen clínico a la solicitud de los estudios para que en el laboratorio se puedan optimizar las estrategias diagnósticas del estudio.