Читать книгу Interventional Cardiology - Группа авторов - Страница 61

Hemostatic patches were originally designed for military purposes to achieve temporary arterial hemostasis in the battlefield. The mechanisms of action include causing vasoconstriction, creation of a positively charged environment, which attracts negatively charged red blood cells and platelets, or direct promotion of rapid coagulation [31–33]. Available patches include: Syvek Patch using poly‐N‐glucosamine (Marine Polymer Technologies, Danvers, MA); Neptune pad using calcium alginate (Biotronik, Bulach, Switzerland); Closure PAD (Medtronic, Santa Rosa, CA); Chito‐Seal using chitosan gel (Abbott Vascular, Redwood, CA); SafeSeal using a microporous polysaccharide (Possis Medical, Minneapolis MN, formerly Stasys Patch, St. Jude Medical, St. Paul, MN); and D‐ Stat Dry using thrombin (Vascular Solutions, Minneapolis, MN) (Table 2.1) [31].

Hemostatic patches allow sheath removal in anticoagulated patients, with ACT as high as 300 seconds. Studies on hemostatic patches have generally demonstrated shorter time to hemostasis and ambulation. However, a period of manual compression is generally required and may be longer than the recommended compression times from manufacturers [33–35]. It is likely a combination of both hemostatic properties of the patch and manual compression that leads to hemostasis. There are no consistent data demonstrating reduction in vascular complications with the use of hemostatic patches over manual compression. Neither the Syvek patch nor Chito‐Seal has been shown to reduce vascular complications over manual compression in a review of cases registered with the American College of Cardiology‐National Cardiovascular Data Registry (ACC‐ NCDR) [36]. D‐Stat Dry used after diagnostic procedures reduced vascular complications compared to manual compression in a series utilizing a historical control [33], but no direct comparisons have been performed. As the complication rate from vascular puncture in general appears to be declining with time, direct comparisons are necessary to clearly demonstrate decreased complication rates using these patches [4]. There are now several other patches available.