Vascular Access-Related Complications in Women: Temporal Trends, Emerging Data, and the Current State of Interventional Cardiology Practice

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Abstract

Women undergoing cardiac catheterization, percutaneous coronary intervention, transcatheter aortic valve replacement, and other structural heart interventions have a significantly higher risk of vascular complications and bleeding than men, leading to significant morbidity and mortality. This review highlights the importance of recognizing female sex as a specific and independent risk factor, and focuses on mechanisms of increased risk and strategies to minimize that risk. Smaller caliber peripheral vessels, low body weight, variations in platelet reactivity, and inappropriate dosing of anticoagulant and antiplatelet agents are the currently identified mechanisms for elevated bleeding and vascular complication risk in women. Radial-preferred access, smaller caliber sheaths, imaging-guided arterial puncture, and more judicious anticoagulant dosing have led to reduced bleeding and vascular complication rates in both sexes, especially women. Obtaining proficiency in these strategies should be a priority for operators in order to improve safety and procedural outcomes in women.

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