Comparison of Modified Manual Compression Technique with Traditional Manual Compression for Haemostasis After Transfemoral Coronary Angiography: Analysis of a Randomised Controlled Study

Background: A recent pilot study showed that a modified manual compression (MMC) technique significantly reduced time to haemostasis (TTH) for patients undergoing elective transfemoral coronary angiography compared to traditional manual compression (TMC). The aim of this randomised controlled study was to conduct a larger-scale trial to validate the results of the pilot study. Methods: Between February 2017-December 2018, 122 patients undergoing transfemoral cardiac catheterisation were randomised to post-procedural haemostasis with TMC or MMC in a 1:1 fashion. The primary endpoint was TTH, defined as time at which no further blood ooze was seen at the puncture site for 5 minutes. Secondary outcomes included ACUITY minor bleeding post-procedure and at a 1 week follow-up. Both compression techniques were conducted by the same experienced nurses and registrars. Results: Mean age was 64.66 years, 74% were male (n = 91), mean heparin dosage was 3602 units and 38.5% had diabetes (n = 47). 28.7% of patients underwent percutaneous coronary intervention (PCI) (n = 35). Baseline clinical characteristics were well watched between the groups, with also no significant difference in antiplatelet and anticoagulant usage or intra-procedural heparin dosage. TTH was significantly reduced in the MMC group compared to TMC [median (IQR): 8.10 (7.1–11.1) vs. 11.75 (9.85–15.1) minutes; p < 0.001]. There was no significant difference in minor bleeding post-procedure and at 1 week. Conclusion: MMC significantly reduces TTH for a broader patient group, including those undergoing transfemoral PCI. This reduction may translate to earlier patient ambulation and increased efficiency of hospital resource utilisation.