Procedural-related bleeding : transradial approach versus transfemoral approach in coronary angioplasty

Abstract

Overview of the topic: A Percutaneous Coronary Intervention (PCI) is a procedure that involves the insertion of a catheter from a small incision site. Contrast dye is then injected to highlight the arteries of the heart. A stent is then inserted to restore the blood flow from blocked arteries (WebMD, 2019). In this dissertation, the amount of blood loss which results from the transradial and transfemoral approaches of a PCI will be studied. The Research Question: Is the procedural-related blood loss reduced in the transradial approach when compared to the transfemoral approach, in adults undergoing coronary angioplasty? The PICO Elements: The population (P) studied was adults undergoing coronary angioplasty. The intervention (I) observed was the transradial approach, whilst the comparison (C) was the transfemoral approach. The final desired outcome (O) was procedural-related blood loss. Method: The key elements of the PICO question were used and combined using the Boolean Operators to retrieve articles. The databases used are EBSCO, Scopus, PubMed, and MEDLINE. The PRISMA 2009 checklist was used to include the relevant articles only. Limiters and inclusion and exclusion criteria were applied to limit searches. The Critical Appraisal Skills Programme tool was used to highlight the strengths and weaknesses of the articles. Results: A total of five key studies were identified. These included one systematic review and four cohort studies. Four articles found that the transradial approach showed a significant reduction in bleeding when compared to the transfemoral approach, whereas one cohort study showed no difference between the two approaches. Conclusion: A definite conclusion could not be presented although it can be said that from the evidence gathered the transradial approach has reduced blood loss. However, further research is required to answer the PICO question. Implications and Recommendations: Following a healthy lifestyle will decrease heart disease and thus, reduces the number of required PCIs. Further research using larger sample sizes should be conducted for consistent results.