The safety of two-hour versus four-hour bed rest after elective 6-French femoral cardiac catheterization

Abstract

The use of reduced cardiac catheter sizes together with increased nursing expertise in post-procedural care has resulted in cardiac catheterization becoming a day-case procedure. This trial examined the frequency of local vascular complications (bruising, arterial bleeding, haematoma formation and pseudo-aneurysm formation) in 305 patients admitted to a tertiary cardiothoracic centre for diagnostic 6-French transfemoral angiography with bed rest of 2 h or 4 h. The frequency of local vascular complications was noted hourly for the first 4 h, then again at 24 h and at 1 month post discharge. There was a trend towards fewer local vascular complications in the ‘two hour group’ compared to the ‘four hour group’. No patients developed a pseudo-aneurysm or required transfusion. The odds ratio for presence of haematoma at 4 h when comparing the ‘two hour group’ against the ‘four hour group’ is 0.13 (95% CI 0.01 to 1.66; P = 0.12), after adjustment for baseline characteristics. The corresponding odds ratio for presence of bruising is 0.74 (0.26 to 2.09; P = 0.57). Therefore, this study shows no evidence against mobilizing patients 2 h after 6-French transfermoral coronary angiography. The sample size of 300 gives a probability of 80% that the upper 95% confidence limit for the difference in event rates between the ‘two hour group’ and the ‘four hour’ group will not exceed 0.11.