Percutaneous coronary intervention with bivalirudin anticoagulation, immediate sheath removal, and early ambulation: A feasibility study with implications for day-stay procedures

We assessed the feasibility and safety of a strategy of transfemoral percutaneous coronary intervention (PCI) with bivalirudin anticoagulation, immediate sheath removal, early ambulation, and, where possible, same‐day discharge in 100 consecutive patients. Ambulation was achieved by 2 hr 30 min in 85% of patients and same‐day discharge in 26%. PCI was angiographically successful in 97%. In hospital, there were no deaths or Q‐wave myocardial infarctions. One patient suffered a non–Q‐wave infarction, another in‐hospital surgical revascularization and one required blood transfusion for rectal bleeding. Femoral access site hematoma > 5 cm diameter occurred in two patients. In addition, by 1 month there had been one death (at 10 days) and one pseudoaneurysm treated nonsurgically. In this preliminary study, the strategy of bivalirudin bolus anticoagulation, immediate sheath removal, and 2‐hr ambulation after PCI appeared safe, with same‐day discharge possible in 26% of unselected patients with stable or unstable angina. Cathet Cardiovasc Intervent 2002;55:289–293. © 2002 Wiley‐Liss, Inc.