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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

Network of the included vascular closure devices and rank probability plot derived from the network meta-analysis with respect to the risk for femoral artery puncture-related combined adverse vascular events (a,b) and hematomas (c,d).The figures in the lines of the network graph represent the number of direct comparisons between each pair of treatments. The rank probability plot produced by the network meta-analysis estimates the probability of each treatment being the best, the second best, etc.
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f4: Network of the included vascular closure devices and rank probability plot derived from the network meta-analysis with respect to the risk for femoral artery puncture-related combined adverse vascular events (a,b) and hematomas (c,d).The figures in the lines of the network graph represent the number of direct comparisons between each pair of treatments. The rank probability plot produced by the network meta-analysis estimates the probability of each treatment being the best, the second best, etc.

Mentions: Forty studies including 16051 patients were included in this network meta-analysis. Eight types of VCDs—AngioSeal, VasoSeal, QuickSeal, ExoSeal, FemoSeal, Perclose (Prostar/Techstar/Proglide), Duett and StarClose—were included for evaluating the CAVE risk (Fig. 4a). Node-splitting analysis showed that there were no significant differences between the direct and indirect comparisons (Supplementary Table S2). Therefore, a consistency model was used to evaluate the relative effect of the included VCDs and MC (Random effects, RR: 0.54, CI: 0.33–0.82). The relative effects of the included VCDs and MC were identical when we excluded two studies2749 conducted in the East Asian population (Random effects, RR: 0.55, CI: 0.33–0.83) or two non-English language studies2949 (Random effects, RR: 0.55, CI: 0.33–0.83), respectively. The current network meta-analysis showed that AngioSeal reduced the risk of CAVE compared with MC (Random effects, RR: 0.67, CI: 0.46–0.98). The other VCDs were associated with a similar risk for CAVE in comparison with MC. Moreover, there were no significant differences with regard to the risk for CAVE between these VCDs (Table 2). The rank probability plot indicated that AngioSeal might be the best VCD (Fig. 4b).


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)

Network of the included vascular closure devices and rank probability plot derived from the network meta-analysis with respect to the risk for femoral artery puncture-related combined adverse vascular events (a,b) and hematomas (c,d).The figures in the lines of the network graph represent the number of direct comparisons between each pair of treatments. The rank probability plot produced by the network meta-analysis estimates the probability of each treatment being the best, the second best, etc.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4: Network of the included vascular closure devices and rank probability plot derived from the network meta-analysis with respect to the risk for femoral artery puncture-related combined adverse vascular events (a,b) and hematomas (c,d).The figures in the lines of the network graph represent the number of direct comparisons between each pair of treatments. The rank probability plot produced by the network meta-analysis estimates the probability of each treatment being the best, the second best, etc.
Mentions: Forty studies including 16051 patients were included in this network meta-analysis. Eight types of VCDs—AngioSeal, VasoSeal, QuickSeal, ExoSeal, FemoSeal, Perclose (Prostar/Techstar/Proglide), Duett and StarClose—were included for evaluating the CAVE risk (Fig. 4a). Node-splitting analysis showed that there were no significant differences between the direct and indirect comparisons (Supplementary Table S2). Therefore, a consistency model was used to evaluate the relative effect of the included VCDs and MC (Random effects, RR: 0.54, CI: 0.33–0.82). The relative effects of the included VCDs and MC were identical when we excluded two studies2749 conducted in the East Asian population (Random effects, RR: 0.55, CI: 0.33–0.83) or two non-English language studies2949 (Random effects, RR: 0.55, CI: 0.33–0.83), respectively. The current network meta-analysis showed that AngioSeal reduced the risk of CAVE compared with MC (Random effects, RR: 0.67, CI: 0.46–0.98). The other VCDs were associated with a similar risk for CAVE in comparison with MC. Moreover, there were no significant differences with regard to the risk for CAVE between these VCDs (Table 2). The rank probability plot indicated that AngioSeal might be the best VCD (Fig. 4b).

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