Abstract
Despite the increasing use of transradial techniques for cardiac percutaneous procedures, none of the strategies commonly utilized for hemostasis has been able to reduce the occurrence of radial artery occlusion (RAO). The aim of this study was to evaluate the occurrence of 24-hour RAO and the rate of bleeding of a novel hemostatic device for radial closure after percutaneous interventions, in adjunct to short-time compression. Once the radial access was obtained, patients were randomized to 3 different strategies of radial closure: a short compression with the QuikClot® Interventional™ pad (Z-Medica Corporation, Wallingford, CT, USA) (15 minutes, group 1), a short compression (15 minutes, group 2), and a conventional prolonged compression (2 hours, group 3) both without QuikClot® utilization. Fifty patients in group 1, 20 in group 2, and 50 in group 3 were enrolled. The three groups were homogenous for baseline and procedural characteristics. None of patients in group 1 developed RAO, 1 (5%) occurred in group 2, and 5 (10%) in group 3 (P = 0.05). Active bleeding after compression removal occurred in 10 patients (20%) in group 1, 18 (90%) in group 2, and 1 (2%) in group 3 (P < 0.001). Among patients in group 1, at univariate analysis, the predictors of acute bleeding resulted in chronic therapy with clopidogrel (Odds Ratio 28.78, 95% Confidence Intervals 4.79-172.82, P < 0.001) and high levels of activated clotting time (ACT) at the time of sheath removal (OR 1.02, 95% CI 1.00-1.03, P = 0.009). At ROC analysis, the cutoff value of ACT for the risk of bleeding with a sensitivity of 80% and specificity of 75% was 287 seconds. Early sheet removal and short-time compression with QuikClot® Interventional™ can reduce the rate of RAO after diagnostic or interventional procedures especially in patients not on double antiplatelet therapy.
Highlights
Transradial access for percutaneous cardiovascular procedures provides a low rate of local complications and similar clinical results compared to other sites of access.[1,2,3] Sheath removal after transradial catheterization is conventionally based on external compressionVol 24, No 1, 2011 POLITI, ET AL.it seems reasonable to preserve radial patency by keeping compression time as short as possible
The enrollment in group 2 was stopped after the 20th patient because of high rate of active bleeding after compression removal (18 out of 20 patients)
This trial tested the occurrence of 24-hour radial artery occlusion (RAO) and the rate of bleeding after compression removal comparing a short compression with the QuikClot R InterventionalTM pad versus two other strategies, a short compression and a conventional prolonged compression both without QuikClot R utilization
Summary
Transradial access for percutaneous cardiovascular procedures provides a low rate of local complications and similar clinical results compared to other sites of access.[1,2,3] Sheath removal after transradial catheterization is conventionally based on external compressionVol 24, No 1, 2011 POLITI, ET AL.it seems reasonable to preserve radial patency by keeping compression time as short as possible. The larger platelets and clotting factor molecules remain in the wound in a highly concentrated form promoting a rapid natural clotting The aim of this prospective three-arm randomized study was to evaluate the safety and efficacy of QuikClot R in adjunct to short-time compression, compared to either short- or prolonged-time compression techniques with conventional sterile gauzes after transradial diagnostic or interventional coronary procedures. The aim of this study was to evaluate the occurrence of 24-hour RAO and the rate of bleeding of a novel hemostatic device for radial closure after percutaneous interventions, in adjunct to short-time compression. Conclusions: Early sheet removal and short-time compression with QuikClot R InterventionalTM can reduce the rate of RAO after diagnostic or interventional procedures especially in patients not on double antiplatelet therapy. Conclusions: Early sheet removal and short-time compression with QuikClot R InterventionalTM can reduce the rate of RAO after diagnostic or interventional procedures especially in patients not on double antiplatelet therapy. (J Interven Cardiol 2011;24:65–72)
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