Effects of Cold Compress on Pain and Vascular Complications in Patients With Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis.

backgroundTransfemoral percutaneous coronary intervention (PCI), a widely adopted treatment for coronary artery disease, is frequently accompanied by vascular complications such as pain, bleeding, ecchymosis, and hematoma. Although cold compress application has been suggested to mitigate these complications as a simple, nonpharmacological intervention, the evidence regarding its effectiveness is inconsistent. PURPOSE: The goal of this meta-analysis is to evaluate the effectiveness of cold compresses in alleviating pain and preventing vascular complications in patients undergoing transfemoral PCI.

methodsFour significant databases (Embase, Medline, Cochrane, CINHAL database), gray literature, and the Clinical Trials Registry were searched using the following keywords: P: "transfemoral percutaneous coronary interventions" OR "coronary interventions"; I: "cold pack" OR "cold compress" OR "ice-bag"; and O: "vascular complications" OR "adverse reactions" OR "pain." Two independent authors screened the studies based on predefined inclusion criteria, and any discrepancies were resolved through discussion. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were synthesized using statistical methods to calculate the standardized mean difference (SMD) for pain levels and risk ratios (RR) for outcomes such as hematoma, ecchymosis, and bleeding. This research was registered in the PROSPERO database (CRD420251018936).

resultsTen randomized controlled trials (RCTs) involving 904 participants were included in the analysis. The results of the pooled analyses showed cold compresses significantly reduced puncture-site pain (SMD=-1.56, 95% CI [-2.86, -0.25]), bleeding (RR=0.30, 95% CI [0.18, 0.52]), and hematoma (RR=0.30, 95% CI [0.10, 0.91]) and demonstrated a detectable but nonsignificant reduction effect on ecchymosis incidence (RR=0.38, 95% CI [0.10, 1.36]). The results of the subgroup analyses revealed consistent protective effects for bleeding and hematoma, although pain and ecchymosis outcomes exhibited moderate-to-high heterogeneity based on specific intervention modality. The methodological quality of the included studies was assessed to be moderate to high (JBI scores: 9-12). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings support cold compresses as effective in alleviating puncture-site pain and reducing bleeding and hematoma following transfemoral PCI, with a possible beneficial effect on ecchymosis. Despite protocol variability and the absence of blinding across trials, the overall evidence supports the clinical application of cold compresses as a safe, low-cost, and nonpharmacological adjunct to standard post-PCI care. To optimize outcomes, standardized intervention protocols, including timing, temperature, weight, and duration, should be adopted in future trials. Based on the current evidence, the use of a cold pack (100-250 g, maintained at 15°C-20°C, applied for 15-20 min after manual compression) is recommended to enhance patient comfort and recovery in routine nursing practice.