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Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

Jiang J, Zou J, Ma H, Jiao Y, Yang H, Zhang X, Miao Y - Sci Rep (2015)

Bottom Line: The safety of vascular closure devices (VCDs) is still debated.Moreover, the use of VCDs reduced the risk of haematomas compared with MC.In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China.

ABSTRACT
The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

No MeSH data available.


Related in: MedlinePlus

Subgroup analysis stratified by the year of publication accessing the risk of combined adverse vascular events of VCDs versus MC.VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.
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f2: Subgroup analysis stratified by the year of publication accessing the risk of combined adverse vascular events of VCDs versus MC.VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.

Mentions: Subgroup analysis of all the different types of VCDs except FemoSeal, which was associated with a significantly reduced risk of CAVE (Random effects, RR: 0.75, CI: 0.60–0.94, P = 0.01), showed similar results (Table 1). Taking into account the technical and design improvements of VCDs and increase in operator experience in the past decade, the application of VCDs after 2005 was associated with a decreased risk of VCD-associated complications. Subgroup analysis stratified by the year of publication revealed a trend toward decreased risk of CAVE in trials published after 2005 (Fig. 2). Similar results were found when we excluded two studies2749 conducted in the East Asian population (Supplementary Fig. S3) or two non-English language studies2949 (Supplementary Fig. S4), respectively, to explore the potential bias resulted from different populations and languages.


Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

Jiang J, Zou J, Ma H, Jiao Y, Yang H, Zhang X, Miao Y - Sci Rep (2015)

Subgroup analysis stratified by the year of publication accessing the risk of combined adverse vascular events of VCDs versus MC.VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562233&req=5

f2: Subgroup analysis stratified by the year of publication accessing the risk of combined adverse vascular events of VCDs versus MC.VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.
Mentions: Subgroup analysis of all the different types of VCDs except FemoSeal, which was associated with a significantly reduced risk of CAVE (Random effects, RR: 0.75, CI: 0.60–0.94, P = 0.01), showed similar results (Table 1). Taking into account the technical and design improvements of VCDs and increase in operator experience in the past decade, the application of VCDs after 2005 was associated with a decreased risk of VCD-associated complications. Subgroup analysis stratified by the year of publication revealed a trend toward decreased risk of CAVE in trials published after 2005 (Fig. 2). Similar results were found when we excluded two studies2749 conducted in the East Asian population (Supplementary Fig. S3) or two non-English language studies2949 (Supplementary Fig. S4), respectively, to explore the potential bias resulted from different populations and languages.

Bottom Line: The safety of vascular closure devices (VCDs) is still debated.Moreover, the use of VCDs reduced the risk of haematomas compared with MC.In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China.

ABSTRACT
The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

No MeSH data available.


Related in: MedlinePlus