The Population at Risk of Developing Complications From Vascular Hemostasis Essay

Introduction

Reynaud et al. (2015) posit that the increase in age is a significant factor that leads to the exponential risk of both the venous and the arterial thrombotic events. Additionally, the second half of the 20th century led to the improvement of the life expectancy that in turn led to the contemporary surge in the cases of venous and arterial thrombosis. Age increase the risk of the condition for various reasons that include but not limited to the degeneration of the arterial wall, the increase in the immobility that often results into venous stasis, reduction of the regularity of exercising, and the improvement of systematic activation of the coagulation of blood (Reynaud et al., 2015). Closely related to that is the fact that coagulation factors that include factors V, VII, VII, and IX increase methodically as one ages. Individuals aged above 47 years also have a significant increase of Willebrand factor or the vWF. Old people tend to have higher levels of plasma that is responsible for the high occurrence of cardiovascular events.

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Barbui et al. (2014) claim that as someone ages, they tend to develop laboratory enhancement of enzymatic coagulators that is normally depicted by higher degrees of activation peptides adopted from prothrombin factor X, fibrinogen, and factor IX. The conversion of the mentioned factors or the zymogens to the respective enzymes increases the risk of developing TAT or thrombin-anti-thrombin complex. Additionally, aging is associated with the impairment of fibrinolytic activity that has a direct correlation with the occurrence of thrombin. That is so because it leads to the development of the inhibitor type 1, which is plasminogen (Barbui et al., 2014). Aging also leads to platelet reactivity that significantly the generation of thrombin. For example, the platelets of people above 60 years tend to aggregate more rapidly to correspond to the production of collagen or adenosine diphosphate (ADP), which is not the case with younger individuals. It is worth noting that the vascular endolethium is exceedingly important in the hemostasis, meaning that the slightest change in the functional or the structural composition of the vascular wall (mainly affected by aging), and meaning that it is a causal factor to thrombosis. Finally, aging comes with dilation and stiffness of the arteries caused by the increase in calcium and collagen, and the degeneration of the elastic fibers. Evidently, several factors lead to the changes in the hemostatic system among the elderly. The noted alterations lead to thrombosis.

Post-Intervention Local Complications from Vascular Hemostasis Interventions

Donald et al. (2017) argue that t is imperative to note that patients that undergo percutaneous interventions tend to have abnormal or peculiar hemostasis. Such is possible due to the changes in the cell's protein-based coagulation system, the deficiency in the functions of platelet function, and a combination of deficits that may include disseminated intravascular coagulation. Hemostasis refers to an elaborate process that involves plasma enzymes, the walls of the blood vessels, and platelets (Donald et al., 2017). The mentioned factors often interact in an enclosed, highly coordinated system that leads to the formation of platelets plug that is fibrin-rich. Hemostatic deficits occur due to the insufficiency in the quantity platelets, the malfunction of the coagulation system that is protein based, and deficiency in the functionality of the proteins. The alteration of Protein-based and platelets-based coagulation system normally occur due to several pharmacotherapy sessions and medical illnesses. In most patients, the two tend coexist.

The most common methods for the confirmation of the degree of severity of the coronary occlusion and the subsequent treatment include percutaneous coronary intervention PCI) and coronary angiography (CA) (Wu et al., 2015). The nurse should advise the patients to lie down after undergoing the stated procedure or any of them. It is worth noting that the duration of bed rest or confinement is different based on the unit protocol. The leg and hip mobility are often restricted because of the use of bandages on puncture sites and the evident long durations of confinement. The patients tend to complain of the soreness of the back. Additionally, the patients who rely on compression bandages for the management of hemostasis after a coronary procedure are incessantly affected severe leg, groin, and back pains. Traditional compression hemostasis is in close association with vascular-related complications. The most notable complications in that regard include the formation of the hematoma, bleeding, embolism, peripheral arterial thrombosis, the formation of the arteriovenous fistula, and infections.

Various closure devices exist for hemostasis, particularly after the removal of the catheter. The most notable device is the angioseal that is preferred due to its ease of placement that informs the popularity for the use in hemostasis. The angioseal usually achieves the desired effect between 5-7 hours and the patients stay bedridden for a maximum of 4 hours after the procedure. Additionally, the incidences that arise after the application of angioseal hemostasis are minimal ranging from 0.7-4.2% (Wu et al., 2015). The factors permit the patient to return to routines much earlier and faster. The efficacy and the safety of the of angioseal hemostasis after the coronary procedures (performed by the femoral puncture) are quite real and medically proven. As stated, it permits the patients to return early to routine but the data on its effectiveness, especially in minimizing complication, is inconclusive. Angioseal tends to achieve hemostasis faster than the traditional methods. Moreover, it promotes early ambulation, and discharge, improved the patient's comfort, lowered the rate of vascular complication, and caused delayed bleeding. Nevertheless, there are increased complications associated with the application of angioseal (Wu et al. 2015).

Wu et al., (2015) noted that various factors, other than hemostasis, affect the rates of complications among patients. Specifically, the rate of complications tends to be higher when nurses use larger catheters on patients and it always varies depending on the access site. Based on the access site, the complications on radial, femoral, and brachial artery tend to increase in that particular order (Sanghvi, Montgomery, & Varghese, 2018). Moreover, the complication rates differ based on the various coronary procedures. For example, the rates are normally higher with interventional procedures (which include angioplasty and stent placement) in comparison to diagnostic coronary procedures. Various patient-related factors that include sex, age, body mass index (BMI), blood pressure, and medical history influence the complication rates (Wu et al., 2015).

Barbui et al., (2014) observed that certain factors such as renal failure, female sex, age above 70 years, and past treatment with different coronary procedures have a significant relationship with vascular complications. For patients under transfemoral coronary procedures, there seem to be complications among females aged above 70 years that have obstructive pulmonary disease, hemorrhagic disease, peripheral vascular disease, heart failure, and renal failure (Wu et la., 2015). The formation of the hematoma increases with the BMI. The rate of vascular complication is higher in patients that show high systolic pressure during cardiac cauterization when compared to the patients with normal or lower systolic pressure.

References

Barbui, T., Carobbio, A., Rumi, E., Finazzi, G., Gisslinger, H., Rodeghiero, F. & Bertozzi, I. (2014). In contemporary patients with polycythemia Vera, rates of thrombosis and risk factors delineate a new clinical epidemiology. Blood, 124(19), 3021-3023.

Donald, J., Rixey, A., Hill, J., & Johnson, P. (2017). Carotid Blowout Syndrome: Efficacy of Endovascular Treatment Methods. Medical Imaging and Interventional Radiology, 3.

Reynaud, Q., Lega, J. C., Mismetti, P., Chapelle, C., Wahl, D., Cathebras, P., & Laporte, S. (2014). Risk of venous and arterial thrombosis according to type of antiphospholipid antibodies in adults without systemic lupus erythematosus: a systematic review and meta-analysis. Autoimmunity Reviews, 13(6), 595-608.

Sanghvi, K. A., Montgomery, M., & Varghese, V. (2018). Effect of hemostatic device on radial artery occlusion: A randomized comparison of compression devices in the radial hemostasis study. Cardiovascular Revascularization Medicine.

Wu, P. J., Dai, Y. T., Kao, H. L., Chang, C. H., & Lou, M. F. (2015). Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for hemostasis. BMC Cardiovascular Disorders, 15(1), 34.