Randomized Comparison of 3 Hemostasis Techniques After Transradial Coronary Intervention

Cong, Xiaoliang; Huang, Zhigang; Wu, Jia Rong; Wang, Jiamei; Wen, Feng; Fang, Lingling; Fan, Min; Liang, Chang-Min

doi:10.1097/jcn.0000000000000268

Cited by 14 publications

(18 citation statements)

References 13 publications

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“…Of those, 28 articles were excluded because either no RAO/UAO rates were reported or they were reviews/editorials or meta‐analyses not reporting original data on RAO/UAO rates, whereas 5 studies were excluded because they were duplicate reports (Figure ). Finally, 112 original articles assessing RAO and/or UAO were deemed eligible for our meta‐analysis, of which 99 cohorts from 92 studies publishing RAO…”

Section: Resultsmentioning

confidence: 99%

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

Hahalis

Aznaouridis

Tsigkas

et al. 2017

JAHA

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BackgroundIncidence of radial artery occclusions (RAO) and ulnar artery occclusions (UAO) in coronary procedures, factors predisposing to forearm arteries occlusion, and the benefit of anticoaggulation vary significantly in existing literature. We sought to determine the incidence of RAO/UAO and the impact of anticoagulation intensity.Methods and ResultsMeta‐analysis of 112 studies assessing RAO and/or UAO (N=46 631) were included. Overall, there was no difference between crude RAO and UAO rates (5.2%; 95% confidence interval [CI], 4.4–6.0 versus 4.0%; 95% CI, 2.8–5.8; P=0.171). The early occlusion rate (in‐hospital or within 7 days after procedure) was higher than the late occlusion rate. The detection rate of occlusion was higher with vascular ultrasonography compared with clinical evaluation only. Low‐dose heparin was associated with a significantly higher RAO rate compared with high‐dose heparin (7.2%; 95% CI, 5.5–9.4 versus 4.3%; 95% CI, 3.5–5.3; Q=8.81; P=0.003). Early occlusions in low‐dose heparin cohorts mounted at 8.0% (95% CI, 6.1–10.6). The RAO rate was higher after diagnostic angiographies compared with coronary interventions, presumably attributed to the higher intensity of anticoagulation in the latter group. Hemostatic techniques (patent versus nonpatent hemostasis), geography (US versus non‐US cohorts) and sheath size did not impact on vessel patency.ConclusionsRAO and UAO occur with similar frequency and in the order of 7% to 8% when evaluated early by vascular ultrasonography following coronary procedures. More‐intensive anticoagulation is protective. Late recanalization occurs in a substantial minority of patients.

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Section: Resultsmentioning

confidence: 99%

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

Hahalis

Aznaouridis

Tsigkas

et al. 2017

JAHA

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“…Among the frequent predictive parameters with uniformly positive association with RAO, female gender was reported in 4 studies, 5,9,11,15,19 but the most frequently found risk factors were lower body size, lower body weight as well as their surrogates (eg, wrist size, sheath-to-RA diameter size etc). 11,15,20,21 –33 History of diabetes mellitus, smoking or atherosclerotic disease, 11,15,23,30,35 lower blood pressure 9,11,31,36 as well as complicated RA access and spasm 5, 28,36 –38 also appear predictive of RAO. Other variables associated with RAO include longer procedural and fluoroscopy duration, 9,11,31,39 shorter procedural time, 27,40 lower anticoagulation intensity, 9,10,16, 28 ,33,44 nonpatent RA during hemostasis or no “patent hemostasis” technique used, 25,30,35 or longer hemostasis or bandage time.…”

Section: Predictors Of Raomentioning

confidence: 99%

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

et al. 2018

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Radial artery (RA) occlusion (RAO) remains the Achilles heel of transradial coronary procedures. Although of silent nature, RAO is relatively frequent, results in graft shortage for future coronary artery bypass surgery, and may occur even after short-lasting, 5F coronary angiography (CAG). The most frequent predictors of RAO are RA size, body size, female gender, and periprocedural anticoagulation intensity. Methods to detect RAO are variable, of which the Barbeau test and ultrasonography have similar diagnostic accuracy. Data indicate that late RAO recanalization may occur. Meticulous handling of RA and the use of appropriate hemostatic devices and techniques along with sufficient heparin dose appear important measures to reduce RAO rates. Recent contradictory studies indicate that the decreasing incidence of RAO overtime is not as uniform as previously thought. In 2 meta-analyses, the benefit of higher over lower anticoagulation intensity became evident. As "it may all be appropriate anticoagulation" for a simplified approach against RAO, the results of an ongoing trial comparing 100 with 50 IU/kg body weight in transradial CAG are eagerly awaited.

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“…Compression devices (CD) or hemostasis pads are popular methods for bleeding control after radial artery punctures. [11–13] In this study, we hypothesized that the combination of CD and chitosan-based pads would improve the hemostasis efficacy compared with CD alone after transradial coronary angiography or interventions.…”

Section: Introductionmentioning

confidence: 99%

Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial

et al. 2017

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BackgroundArterial access and hemostasis are important processes during percutaneous coronary procedures. In this study, we tested if the use of chitosan-based pads on top of compression devices could improve hemostasis efficacy compared with compression devices alone after transradial coronary angiography or interventions.MethodsThis study was a single-center open-label randomized controlled trial. Patients who underwent coronary angiography or intervention with the transradial approach were randomly assigned to the study (compression device and a chitosan-based pad) or control (compression devices alone) group in a 2:1 fashion. The primary endpoint was time to hemostasis, categorized into ≤5, 6–10, 11–20, and >20 minutes.ResultsBetween April and July 2016, 95 patients were enrolled (59 were assigned to the study arm and 36 to the control arm). Time to hemostasis, the primary endpoint, was significantly lower in the study group than in the control group (p<0.001). Both groups showed low rates of vascular complications.ConclusionsThis study suggests that the use of a hemostasis pad in combination with rotatory compression devices is a safe and effective hemostasis strategy after radial artery access.Trial registrationClinicalTrials.gov NCT02954029

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Randomized Comparison of 3 Hemostasis Techniques After Transradial Coronary Intervention

Abstract: Hemostasis devices have comparative advantages over the conventional pressure dressing. The presence of radial artery flow during compression represents a strong predictor of radial artery patency during follow-up periods.

Cited by 14 publications

References 13 publications

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

Radial Artery and Ulnar Artery Occlusions Following Coronary Procedures and the Impact of Anticoagulation: ARTEMIS (Radial and Ulnar ARTE ry Occlusion M eta‐Analys IS ) Systematic Review and Meta‐Analysis

Prevention of Radial Artery Occlusions Following Coronary Procedures: Forward and Backward Steps in Improving Radial Artery Patency Rates

Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial

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