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Review
. 2015 Sep 8:5:13761.
doi: 10.1038/srep13761.

Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis

Jun Jiang  1 , Junjie Zou  1 , Hao Ma  1 , Yuanyong Jiao  1 , Hongyu Yang  1 , Xiwei Zhang  1 , Yi Miao  1
Affiliations
Review

Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis

Jun Jiang et al. Sci Rep. .

Abstract

The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

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Figures

Figure 1
Figure 1. Study flow diagram showing the selection of articles for the meta-analysis.
CENTRAL =  Cochrane Central Register of Controlled Trials, RCT = randomized controlled trial.
Figure 2
Figure 2. Subgroup analysis stratified by the year of publication accessing the risk of combined adverse vascular events of VCDs versus MC.
VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.
Figure 3
Figure 3. Risk of haematomas associated with all VCDs versus MC.
VCD = vascular closure device, MC = manual compression, M-H = Mantel-Haenzel, CI = confidence interval.
Figure 4
Figure 4. Network of the included vascular closure devices and rank probability plot derived from the network meta-analysis with respect to the risk for femoral artery puncture-related combined adverse vascular events (a,b) and hematomas (c,d).
The figures in the lines of the network graph represent the number of direct comparisons between each pair of treatments. The rank probability plot produced by the network meta-analysis estimates the probability of each treatment being the best, the second best, etc.
See this image and copyright information in PMC

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