Impact of radial compression protocols on radial artery occlusion and hemostasis time in coronary angiography

Abstract

Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidence-based protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.

Loss of Radial Artery Pulse after Coronary Catheterization Through Trans-radial Route in Patients Acute Coronary Syndrome

“…0.9% vs. 9.8% with new and conventional protocol, respectively. 16 Even though this study was conducted at the largest cardiac care hospital of the country, but certain limitations bounds the generalizability of study findings which included small sample size and single center coverage.…”

“…Both the intra-arterial and intravenous routes of heparin administration showed equal efficacy with the radial occlusion rates of 5.6% vs. 6.9% after 24 hours of diagnostic coronary angiography, respectively. Considering the importance of compression duration, Takamatsu S et al 16 conducted a study to compare the conventional protocol (the removal of fixed amount of air after two and three hours of the procedure) to the new protocol (the removal of as much of as air after every 30 minutes). With a mean time to achieve the complete hemostasis as 66 ± 32 vs. 190 ± 16 minutes with new vs. old protocol, respectively, a significantly lower rate of radial artery occlusion was noted with the new protocol, i.e.…”

Experiences of cardiac care nurses related to the management and delayed removal of trans-radial band of patients at a private tertiary care hospital, Islamabad

“…Vascular complications can increase the probability of morbidity and mortality, as well as escalate costs for both the patient and the healthcare facility. 9 Therefore, having knowledgeable cardiac nurses is critical. They can not only recognise and treat issues in an appropriate and timely manner, but also help in minimising complications.…”

“…5 In low-income countries, like Pakistan, complications due to cardiovascular diseases are very high, and, therefore, effective measures are needed to decrease complication rates in radial angiography. 6,7 There are numerous post-CC (PCC) complications, and the most common among them are vascular access site complications (VASCs), including bleeding, haematoma, pseudo-aneurysm, arteriovenous fistula, retroperitoneal haemorrhage, and arterial occlusion [7][8][9] as well as device leak. 8 Vascular complications, especially when severe, can increase morbidity and mortality, as well as increase costs for both the patient and the healthcare facility.…”

“…8 Vascular complications, especially when severe, can increase morbidity and mortality, as well as increase costs for both the patient and the healthcare facility. 9 When recognised and treated in an appropriate and timely manner, severe complications can be avoided or mitigated. Nurses play an important role when the cardiologist performs the angiography or CC, from pre-procedure assessment to post-procedure care and discharge.…”