{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:54:49Z","timestamp":1779879289444,"version":"3.53.1"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,2,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Arterial closure devices reduce the length of bedrest after invasive cardiac procedures via the femoral approach, but there are conflicting data on their association with major bleeding and vascular complications. We thus sought to evaluate the contemporary use of femoral arterial closure devices and their association with major bleeding among patients undergoing percutaneous coronary intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We identified patients undergoing percutaneous intervention via the femoral approach within the Veterans Affairs Healthcare System from December 2004 through September 2018. The association between arterial closure device use and major bleeding was evaluated using both propensity matching and instrumental variable analyses, incorporating contrast\u2010induced nephropathy as a falsification end point. We identified 132 373 percutaneous coronary interventions performed by 681 operators, with closure device use increasing 1.2% each year (linear trend\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In a propensity\u2010matched cohort, closure devices were associated with a 1.1% reduction in periprocedural bleeding (95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22121.5% to \u22120.6%). Closure devices were also associated with a numerical decrease in contrast\u2010inducted nephropathy that did not reach statistical significance (\u22120.6%; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22121.3% to 0.1%). In an instrumental variable analysis of closure device use, there was no difference in the bleeding rate between those who received a closure device and those who did not (0.2%; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , \u22120.9% to 1.2%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Arterial closure devices are associated with a reduction in major bleeding within a propensity\u2010matched cohort. This association dissipates in an instrumental variable analysis, highlighting some of the methodologic limitations of comparative effectiveness research in observational analyses.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015223","type":"journal-article","created":{"date-parts":[[2020,2,16]],"date-time":"2020-02-16T10:00:27Z","timestamp":1581847227000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Contemporary Use and Outcomes of Arterial Closure Devices After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program"],"prefix":"10.1161","volume":"9","author":[{"given":"Andrew","family":"Prouse","sequence":"first","affiliation":[{"name":"Division of Cardiology Department of Medicine Denver Health Medical Center Denver CO"},{"name":"Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise","family":"Gunzburger","sequence":"additional","affiliation":[{"name":"Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Yang","sequence":"additional","affiliation":[{"name":"Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Morrison","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier A.","family":"Valle","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO"},{"name":"Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO"},{"name":"Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehrin J.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO"},{"name":"Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W.\u00a0","family":"Waldo","sequence":"additional","affiliation":[{"name":"Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO"},{"name":"Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO"},{"name":"Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.02.027"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.612812"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.12.073"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.20671"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.01.015"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.04.034"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.02.035"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.115.003464"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.03.013"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","first-page":"e003560","DOI":"10.1161\/CIRCINTERVENTIONS.116.003560","article-title":"Relationship between femoral vascular closure devices and short\u2010term mortality from 271 845 percutaneous coronary intervention procedures performed in the United Kingdom between 2006 and 2011: a propensity score\u2010corrected analysis from the British cardiovascular intervention society","volume":"9","author":"Farooq V","year":"2016","unstructured":"Farooq V, Goedhart D, Ludman P, de Belder MA, Harcombe A, El\u2010Omar M; British Cardiovascular Intervention Society and the National Institute for Cardiovascular Outcomes Research . Relationship between femoral vascular closure devices and short\u2010term mortality from 271 845 percutaneous coronary intervention procedures performed in the United Kingdom between 2006 and 2011: a propensity score\u2010corrected analysis from the British cardiovascular intervention society. 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