Is activated clotting time necessary to guide sheath removal in heparinised patients undergoing endovascular intervention for peripheral vascular disease?

The purpose was to evaluate the best practice for arterial sheath management in heparinised patients undergoing endovascular intervention for peripheral vascular disease (PVD) at Eastern Health. Methods Patients undergoing endovascular intervention for PVD at Eastern Health between January 2016 and February 2018 were studied. Those who fulfilled the inclusion criteria were randomly assigned to five interventional radiologists and Category A (sheath removed upon return to recovery without activated clotting time (ACT)), Category B (ACT check 1‐h postheparin and the sheath was removed without knowing the ACT) or Category C (ACT check 1‐h postheparin and sheath removed once ACT < 160; our hospital’s current protocol). Nurses removing sheaths independently have >3 years of experience. Data were collected on baseline clinical characteristics, dose of heparin administered, sheath size and direction, time from heparin administration to sheath removal, time to haemostasis, blood pressure at time of sheath removal and complications. Results A total of 152 patients were included. About 74% of them were males, and the average age was 72 years. There was no significant difference in baseline characteristics influencing complications and other contributing factors. The only significant finding was that Category C experienced the longest mean time to sheath removal (143.4 ± 52.1 min) while Category A experienced the shortest mean time (62.2 ± 27.1 min, P  = 0.0001). There was no significant difference in outcomes. Conclusion There was no significant difference in the outcomes among all groups, and therefore, it shows no reason to routinely measure ACT to guide sheath removal in heparinised patients undergoing endovascular intervention for PVD.