Journal of Invasive Cardiology

ABSTRACT: Heart catheterization is frequently applied in patients with coronary artery disease for diagnostic and therapeutic implications. Using the femoral approach, post-procedure bed rest of 4–6 hours is recommended to prevent groin complications. This extended strict bed rest is associated with patient discomfort and increased medical costs, and interferes with more efficient catheterization laboratory management of referred outpatients. Accordingly, we tested a simple clinical approach to identify low-risk patients who may benefit from ambulation within two hours after sheath removal. Ninety-eight outpatients were stratified to early (time = 1.5–2.0 hours; n = 74) or conventional ambulation (time = 4–5 hours; n = 24) based on difficulties in obtaining arterial access, presence of oozing or hematoma after completing manual compression. Ecchymosis was the most frequent complication, noted in one early ambulated and three conventionally ambulated patients at hospital discharge and in eleven early ambulated and six conventionally ambulated patients at one-week follow-up. No large hematomas, retroperitoneal bleeding or need for blood transfusion occurred in any patients. Using simple clinical parameters, most outpatients who undergo elective diagnostic catheterization may benefit from safe early ambulation.

Key words: early ambulation, heart catheterization

Diagnostic and therapeutic heart catheterizations are common procedures in patients with coronary artery disease (CAD). In the United States alone, over half a million of these procedures are performed each year. The femoral approach to heart catheterization is the most commonly used, and post-procedure bed rest of 4–6 hours is traditionally recommended to prevent bleeding complications. This extended strict bed rest is associated with patient discomfort, extended hospital stay, increased utilization of healthcare resources and difficulties in implementation of an “in-and-out” outpatient catheterization strategy. Although the radial approach is sometimes applied to overcome these difficulties,¹ its utilization has not gained much popularity and early ambulation after the femoral approach plus hemostasis with a sealing device is a costly alternative and used mostly after interventions.² Previous meta-analyses showed that ambulation after two hours compared with six hours carries a similar bleeding risk (6–8%).^3–5 However, in these studies, patients were randomly allocated to the treatment group without risk stratification. We hypothesize that ambulation within two hours is safe in patients stratified as low risk for bleeding complications.