NEW YORK (Reuters Health) – In short (<20 min) coronary angiography procedures with radial artery access, it might be possible to avoid routine heparin administration, a new study suggests.
The key factor is the ability to keep the radial artery open while pressure is being applied for hemostasis after the procedure, according to the research team.
“The study is proof of concept that maintenance of radial artery patency during hemostasis, is at least as effective as systemic anticoagulation in preventing radial artery occlusion after transradial catheterization,” Dr. Samir B. Pancholy, who led the study, told Reuters Health by email.
Dr. Pancholy of The Wright Center for Graduate Medical Education and the Commonwealth Medical College in Scranton, Pennsylvania and colleagues conducted a randomized trial with 400 patients undergoing coronary angiography and left ventriculography via right transradial access with 5 Fr sheaths.
The a priori group received IV heparin immediately after sheath insertion. The “provisional group” did not receive heparin during the procedure.
After sheath removal, patients in the a priori group wore a TR band (Terumo Corporation) for two hours, to achieve hemostasis. Patients in the provisional group also wore a TR band, but they had radial artery patency checked before the band was applied and every 15 minutes afterward. If the artery remained patent, the band was removed after an hour. If the artery thrombosed, patients received a heparin bolus and the band was left in place for two hours, according to a paper online April 10th in the American Journal of Cardiology.
Patent hemostasis was obtained in 67% of the a priori group and 74% of the provisional group. The corresponding rates of radial artery occlusion at 24 hours were 7.5% and 7.0%, and at 30 days, 4.5% and 5.0%.
Overall, say the researchers “our results suggest that if patent hemostasis can be obtained and maintained until hemostasis is completed, heparin can be waived in (approximately) 75% of cases.”
“Conversely,” they add, “if patent hemostasis cannot be achieved and maintained throughout the hemostasis phase, heparin remains mandatory to limit the risk of radial artery occlusion.”
“These findings should not be extrapolated to longer procedure durations,” the authors warn. “Those lasting more than 20 minutes may require the usual heparin dosage.”
Am J Cardiol 2012.