Low Molecular Weight Heparin in Improving RAO After Transradial Coronary Catheterization

Didagelos, Matthaios; Pagiantza, Areti; Zegkos, Thomas; Zarra, Konstantina; Angelopoulos, Vasileios; Κouparanis, Antonios; Peteinidou, Emmanouela; Kassimis, George; Karvounis, Haralambos; Ziakas, Antonios

doi:10.1016/j.jcin.2022.05.047

Cited by 3 publications

(6 citation statements)

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“…As stated above, RAO is the most frequent complication of forearm transradial catheterization, with an overall incidence ranging from 0.8 to 38% depending on several factors [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. RAO incidence is also reported to be lower in patients undergoing PCIs (4.0–4.5%) versus those only having angiography performed (5.9–8.8%) [ 16 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, manual hemostasis was applied only after diagnostic coronary angiography and was found to be an independent predictor of RAO. Presence of symptoms (pain in the forearm or numbness in the fingers of the punctured arm): RAO may be symptomatic in up to 58.8% of patients, presenting as pain in the forearm, numbness/paresthesia, paresis or acute ischemia [ 20 , 22 , 23 , 24 , 25 , 26 ]. Forearm nerve injury may happen either directly, during puncture or during device hemostasis, or indirectly due to radial artery injury, spasms or hematomas and subsequent nerve ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…RAO is the most common complication of transradial catheterization, with a varying overall rate ranging from 0.8 to 38% (with a mean incidence of about 5–10%) in the published literature. This variability can be explained by differences in the timing of evaluations; the methods used for diagnosis (pulse palpation vs. ultrasound) and the periprocedural anticoagulation; and the evolution of the puncture technique (ultrasound-guided), the equipment (lower-profile sheaths and catheters) and hemostatic protocols (patent hemostasis, the simultaneous pressure of both radial and ulnar arteries during hemostasis) [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Moreover, RAO incidence differs when evaluated after a diagnostic coronary angiography only (5.9–8.8%) versus after a PCI (4.0–4.5%) [Rashid2016, Hahalis2017].…”

Section: Introductionmentioning

confidence: 99%

“…Although usually considered asymptomatic, RAO may be symptomatic in up to 31–58.8% of patients, presenting as pain in the forearm, numbness/paresthesia, paresis or acute ischemia [ 20 , 22 , 23 , 24 , 25 , 26 ]. Additionally, in case of RAO, the affected radial artery is excluded from (i) future catheterization procedures, (ii) hemodialysis shunts, (iii) invasive hemodynamic monitoring and (iv) coronary arterial bypass grafting [ 11 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

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Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Didagelos,

Pagiantza,

Papazoglou

et al. 2024

JCM

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Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05–2.83)), (ii) access site cross-over (aOR = 4.33 (1.02–18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00–1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40–4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28–4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29–20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01–3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70–40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06–0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96–0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31–1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42–14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67–32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46–9.87)), either pain (aOR = 2.93 (1.05–8.15)) or numbness (aOR = 4.66 (1.17–18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04–0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Didagelos,

Pagiantza,

Papazoglou

et al. 2024

JCM

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“…Many RAO predictors have been described in the literature, like female gender, older/younger age, lower body size, diabetes mellitus, longer fluoroscopy duration, a higher number of puncture attempts, non-patent hemostasis, and longer hemostasis or bandage time (21)(22)(23). The periprocedural dose of heparin remains the strongest negative predictor of RAO (16,24,25).…”

Section: Discussionmentioning

confidence: 99%

Prevention of radial artery occlusion with rivaroxaban after trans-radial access coronary procedures: The RIVARAD multicentric randomized trial

Hammami

Abid

Jdidi

et al. 2023

Front. Cardiovasc. Med.

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BackgroundRadial artery occlusion (RAO) remains the most frequent complication of trans-radial access. Once the radial artery is occluded, its future use as an access site for coronary procedures, or as a conduit for coronary bypass grafting or fistula for hemodialysis, will be precluded. Therefore, we aimed to assess the value of the short-term use of Rivaroxaban to prevent RAO after a trans-radial coronary procedure.MethodsThis was a prospective, open-label, randomized study. The patients were randomly assigned (1:1) to one of two groups: those who received Rivaroxaban 10 mg for 7 days following the trans-radial coronary procedure (the Rivaroxaban Group) and those who received the standard treatment (the Control Group). The primary outcome was an occurrence of RAO evaluated by Doppler ultrasound at 30 days, and the secondary outcomes were hemorrhagic complications according to BARC classification.ResultsWe included 521 patients randomized into two Groups: the Control Group (N = 262) and the Rivaroxaban Group (N = 259). The 1-month RAO was significantly reduced in the Rivaroxaban Group as compared to the Control Group [6.9% vs. 13%; p = 0.011, OR = 0.5, (95% CI, 0.27–0.91)]. We noted no cases of severe bleeding events (BARC3-5). The overall incidence of minor bleeding (BARC1) was 2.3%, with no significant difference between the two groups [Rivaroxaban Group = 2.7%, Control Group = 1.9%, p = 0.54, OR= 1.4, (95%CI 0.44–4.5)].ConclusionsShort-term postoperative anticoagulation with Rivaroxaban 10 mg for seven days reduces the rate of 1-month RAO.

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Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Tsigkas,

Papanikolaou,

Apostolos

et al. 2023

JCDD

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Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.

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Low Molecular Weight Heparin in Improving RAO After Transradial Coronary Catheterization

Cited by 3 publications

References 4 publications

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Incidence and Prognostic Factors of Radial Artery Occlusion in Transradial Coronary Catheterization

Prevention of radial artery occlusion with rivaroxaban after trans-radial access coronary procedures: The RIVARAD multicentric randomized trial

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

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