Predictors of patent and occlusive hemostasis after transradial coronary procedures

Abstract

Objectives To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures. Background Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath‐vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO. Methods As a part of a previously published study investigating the relationship between residual anticoagulation and risk of RAO, 837 patients undergoing transradial diagnostic coronary angiography or percutaneous coronary interventions were enrolled. Cumulative heparin dose used during the procedure and ACT measured before sheath removal were recorded. PH with reverse Barbeau test was attempted in all patients (NCT02762344). Results PH was less frequently obtained for increasing cumulative heparin dose and ACT values (p < .0001 and p = .0034, respectively). At logistic regression analysis both cumulative heparin dose and ACT values were independent predictors of OH (OR 1.017, 95% IC 1.011–1.023 p < .0001 and OR 1.004, 95% IC 1.001–1.006, p = .0004) while adjusted probability for RAO showed exponential relationship with both parameters. Conclusions The level of anticoagulation is strongly related to the incidence of RAO, and should be taken into account when choosing hemostasis protocol.

Factors influencing radial artery occlusion after transradial coronary intervention in the Indian population

“…. Recently in a prospective, multicenter, ob-servational cohort registry, Pacchioni et al(44) reported a U-shaped relationship with activated clotting time value and RAO in 837 patients who underwent transradial coronary diagnostic angiography or interventions. The paradoxical rise in rates of RAO at increasing ACT was explained by mitigation of the protective effect of high anticoagulation level because of longer hemostasis time, more frequent occlusive hemostasis, and decrease in rate of successful patent hemostasis.…”

Radial artery occlusion after conventional and distal radial access: Impact of preserved flow and time‐to‐hemostasis in a propensity‐score matching analysis of 1163 patients

“…Certainly, PH and minimal inflation protocols depend on different factors, and among them level of anticoagulation and introducer sheath diameter play a pivotal role. 22 Even after adjustment for these confounders, PH rate and consequent effective PF rate was still lower in TRA group, thus confirming the advantages of DRA.…”

“…Thus, in these anatomies, that are not infrequent, 21 distal and conventional puncture potentially differs only for hemostasis protocol and hemostasis time. Certainly, PH and minimal inflation protocols depend on different factors, and among them level of anticoagulation and introducer sheath diameter play a pivotal role 22 . Even after adjustment for these confounders, PH rate and consequent effective PF rate was still lower in TRA group, thus confirming the advantages of DRA.…”

Complicações na descompressão da pulseira hemostática compressiva: uma revisão integrativa

“…Ainda no que se comparam os dois métodos de hemostasia, mesmo que de baixa incidência, a OAR que acomete de 1 a 10% e é também uma das complicações relacionadas ao procedimento, é maior constatada na utilização do método compressivo convencional em relação ao uso da pulseira hemostática (Santos, et al, 2018). Estudos apontam, também, que o nível de anticoagulação e a utilização de introdutor com calibre inadequado, está fortemente relacionado à incidência de OAR, devendo assim, ser realizado uma avaliação prévia do paciente com relação aos fatores de coagulação e seu diâmetro arterial para a seleção adequada do introdutor (Pacchioni, et al, 2021;Lavi, et al, 2020).…”