Prevention Of Radial Artery Occlusion Research Articles

Prevention of radial artery occlusion after transradial angiography and intervention: a best practice implementation project.

Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting. The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention. The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies. The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention. This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future. http://links.lww.com/IJEBH/A261.

Application of 5% lignocaine patch following radial artery access for the prevention of radial artery occlusion: A novel use

Application of 5% lignocaine patch following radial artery access for the prevention of radial artery occlusion: A novel use

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

Radial 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. This 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. We 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)]. Short-term postoperative anticoagulation with Rivaroxaban 10 mg for seven days reduces the rate of 1-month RAO.

Optimal Hemostatic Band Duration After Transradial Angiography or Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.

The optimal duration of hemostatic compression post transradial access is controversial. Longer duration increases the risk of radial artery occlusion (RAO) while shorter duration increases the risk of access site bleeding or hematoma. As such, a target of 2 hours is typically used. Whether a shorter or longer duration is better is not known. A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials of different duration (<90 minutes, 90 minutes, 2 hours, and 2-4 hours) of hemostasis banding. The efficacy outcome was RAO, primary safety outcome was access site hematoma, and secondary safety outcome was access site rebleeding. Primary analysis compared the effect of various duration in reference to the 2 hours duration using a mixed treatment comparison meta-analysis. Of the 10 randomized clinical trials included with 4911 patients, when compared to the 2-hour reference duration, there was a significantly higher risk of access site hematoma with 90 minutes (odds ratio, 2.39 [95% CI, 1.40-4.06]) and <90 minutes (odds ratio, 3.61 [95% CI, 1.79-7.29]) but not with the 2 to 4 hours duration. When compared with the 2-hour reference, there was no significant difference in access site rebleeding or RAO with shorter or longer duration but the point estimates favored longer duration for access site rebleeding and shorter duration for RAO. Duration of <90 minutes and 90 minutes ranked 1 and duration of 2 hours ranked 2 as the most efficacious duration whereas duration of 2 hours ranked 1 and 2 to 4 hours ranked 2 as the safest duration. In patients undergoing transradial access for coronary angiography or intervention, a hemostasis duration of 2 hours offers the best balance for efficacy (prevention of RAO) and safety (prevention of access site hematoma/rebleeding).

Early prevention of radial artery occlusion via distal transradial access for primary percutaneous coronary intervention.

Conventional transradial access (TRA) has been the preferred access for coronary intervention. Recently, distal radial access (DRA) is introduced as an alternative choice to reduce radial artery occlusion (RAO) risk. The study sought to assess the impact of DRA on early RAO using Doppler ultrasound in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). This is a prospective, single-center, open-label randomized clinical trial in which patients with indications for primary PCI from January 2022 to September 2022 were assigned to DRA or TRA group with 100 cases in each group. The primary endpoint was the incidence of forearm RAO, evaluated by Doppler ultrasound before discharge. The rate of access success was comparable between the DRA and TRA groups (98.0 vs. 94.0%, P = 0.279). Compared with the TRA group, longer puncture time was observed in the DRA group [2.4 (1.7-4.2) min vs. 1.7 (1.4-2.3) min; P < 0.001] whereas the door-to-wire time was not delayed in primary PCI [71 (54-88) min vs. 64 (56-82) min, P = 0.103]. Shorter hemostasis time was required in the DRA group [3.1 (2.7-3.3) h vs. 6.2 (5.9-6.4) h; P < 0.001]. Significant reduction of the incidence of forearm RAO was observed in the DRA group (2.0 vs. 9.0%, P = 0.030). Local hematomas ≤ 5 cm was similar in both groups (4.0 vs. 6.0%, P = 0.516), while those > 5 cm were significantly more frequent in the TRA group (0 vs. 6.0%, P = 0.029). Distal radial access is associated with a comparable lower incidence of forearm RAO, shorter hemostasis time, and lower rate of vascular complications compared to TRA in primary PCI. [https://www.chictr.org.cn], identifier [ChiCTR2200061841].

TCT-590 Comparison of Different Doses of Heparin on Prevention of Radial Artery Occlusion After Diagnostic Transradial Catheterization

TCT-590 Comparison of Different Doses of Heparin on Prevention of Radial Artery Occlusion After Diagnostic Transradial Catheterization

Heparin Low Doses and Standard Doses Effect on Trans-Radial Catheterization

Background: Transradial artery is being utilized by an expanding number of interventional cardiologists to perform percutaneous interventions. Nevertheless, occlusion of radial artery (RAO) is prominent after transradial (TR) catheterization. Use of anticoagulant drugs is one way to prevent RAO. The conventional dose of heparin is (2000IU-3000IU or 50IU/kg) and high-dose is (5000IU or 100IU/kg). The use of high-dose heparin and standard-dose heparin is still debatable. Objective: The present study will analyze the non-randomized controlled trials of standard and high dose of heparin for the prevention of radial artery occlusion after transradial catheterization. Methodology: A prospective double-blinded non-randomized controlled trial was carried out. Demographic data related to socio-economic status such as their age, occupation, gender, and smoking habits were collected. Grouping was done so that patients may either be placed in group 1 which will receive 2500UI or into group 2 which will get 5000UI of unfractionated heparin. RAO was the key endpoint of our study. Major bleeding, hematomas and radial artery spasm were secondary outcome measure. Results: 471 patients were made part of this study. 235 patients were placed in group A which received 2500IU and 236 were placed in group B which received 5000IU. RAO was noted to be significantly higher in the group the received the standard dose of UFH as compared to the group that received high dose UFH (8 % vs. 3.3 %, p = 0.005). Female gender (OR: 2.951, 95% CI: 1.57-5.46, p = 0.002), hypertension (OR: 0.02, 95% CI: p = 0.005 and standard dose UFH (OR: 2.822, 95% CI: 1.343 – 5.911, p = . 0.007) were found to be the independent predictors of RAO. Conclusion: Weight-adjusted higher dosage of UFH in TRA for diagnosis yielded remarkable results in reducing the rates of early RAO against the standard administered dosage

Prevention of radial artery occlusion by simultaneous ulnar and radial compression (PRO-SURC). A randomized duplex ultrasound follow-up study

BackgroundThere might be a beneficial effect of transient ulnar artery compression in prevention of radial artery occlusion (RAO) after trans-radial catheterization. ObjectiveThe objective of this study was to assess, by Duplex ultrasound, the efficacy of simultaneous ulnar and radial artery compression (SURC), in prevention of RAO, compared to conventional and patent hemostasis techniques. Patients and methodsFour hundred and fifty consecutive patients undergoing elective trans-radial catheterization were enrolled. Patients were randomized in 1:1:1 fashion into 3 groups; conventional hemostasis (Group A, n = 150 patients), patent hemostasis (Group B, n = 150 patients), and SURC technique (Group C, n = 150 patients). RAO was assessed by duplex ultrasound at 1-h post TR band removal (primary endpoint), and at 1-month. ResultsThe primary endpoint, RAO 1-h post TR-band removal, was significantly lower among patients of group C as compared to those of group A and B (1.3%, 6.7%, and 7.3%, respectively –p = 0.03). This was still consistent at 1-month (0.7%, 8%, and 6%, respectively –p = 0.03). Multiple regression analyses revealed that lower radial artery diameter (RAD) after flow-mediated dilatation (FMD) independently predicted RAO at 1-h, while RAD at 1-h post-TR band removal was the only independent predictor of RAO at 1-month. Receiver operator characteristic (ROC) analysis showed that RAD at 1-h post-TR band removal at cut-off ≤1.75 mm could predict RAO at 1-month with high accuracy (AUC = 0.9, CI = 0.8–1.0, p < 0.001–86% sensitivity, and 95% specificity). ConclusionA technique of SURC is associated with less incidence of early and late RAO compared to conventional hemostasis techniques.

Heparin Low Doses and Standard doses Effect on Transradial Catheterization

Background: Transradial artery is being utilized by an expanding number of interventional cardiologists to perform percutaneous interventions. Nevertheless, occlusion of radial artery (RAO) is prominent after transradial (TR) catheterization. The use of anticoagulant drugs is one way to prevent RAO. The use of high-dose heparin and standard-dose heparin is still debatable. The present study will analyze the non-randomized controlled trials of standard and high doses of heparin for the prevention of radial artery occlusion after transradial catheterization.&#x0D; Methodology: A prospective double-blinded non-randomized controlled trial was carried out. Demographic data on socio-economic statuses, such as age, occupation, gender, and smoking habits, were collected. Grouping was done so that patients may either be placed in group 1, which will receive 2500UI or into group 2, which will get 5000UI of unfractionated heparin. RAO was the critical endpoint of our study. Major bleeding, hematomas, and radial artery spasms were secondary outcome measures.&#x0D; Results: 471 patients were made part of this study. 235 patients were placed in group A which received 2500IU, and 236 were placed in group B, which received 5000IU. RAO was noted to be significantly higher in the group that received the standard dose of UFH as compared to the group that received a high dose of UFH (8 % vs. 3.3 %, p = 0.005). Female gender (OR: 2.951, 95% CI: 1.57-5.46, p = 0.002), hypertension (OR: 0.02, 95% CI: p = 0.005 and standard dose UFH (OR: 2.822, 95% CI: 1.343 – 5.911, p =. 0.007) were found to be the independent predictors of RAO.&#x0D; Conclusion: Weight-adjusted higher dosage of UFH in TRA for diagnosis yielded remarkable results in reducing the rates of early RAO against the standard administered dosage.

Prevention of Radial Artery Occlusion of 3Hemostatic Methods in Transradial Intervention for Coronary Angiography.

The main objective of this study was to compare the efficacy of 3 hemostatic methods for the prevention of early radial artery occlusion (RAO): standard patent hemostasis, patent hemostasis with ulnar compression or the ulnar artery transient compression facilitating radial artery patent hemostasis (ULTRA) method, and facilitated hemostasis with a hemostatic disc. There are no prospective randomized studies that compare early RAO rates with the 3 most used nonocclusive hemostatic methods. This was a prospective, longitudinal, comparative, and randomized study. The final population analyzed was 1,469, and they were randomized into 3 groups: 491 patients in group 1 with standard patent hemostasis, 490 patients in group 2 with the ULTRA method, and 488 patients in group 3 with facilitated hemostasis with a hemostatic disc. The RAO rate at 24 hours of the total population analyzed was 4.6%. By hemostasis groups, it was 3.6% for patent hemostasis, 5.5% for the ULTRA method, and 4.7% for facilitated hemostasis with a hemostatic disc, with no statistical difference among the 3 groups (P=0.387). At 30days, the overall rate of RAO was 1.8%, and by groups, it was 1.4% for the patent hemostasis group, 1.8% for the ULTRA method group, and 2.2% for the facilitated hemostasis with a hemostatic disc group, respectively (P=0.185). The rates of RAO at 24 hours evaluated by plethysmography oximetry and confirmed by ultrasound among 3 current radial hemostasis methods (ie, patent hemostasis, the ULTRA method, and facilitated hemostasis with a hemostatic disc) are not different.

Randomized Clinical Trial on Prevention of Radial Occlusion After Transradial Access Using Nitroglycerin: PATENS Trial.

The aim of this study was to evaluate whether administration of nitroglycerin at the beginning or end of a transradial approach (TRA) procedure would preserve radial patency. The TRA is becoming the preferred vascular access route in coronary interventions. Radial artery occlusion (RAO) is the most frequent complication. Routine vasodilator treatment aims to reduce spasm and possibly prevent RAO. The authors designed a prospective, multicenter, randomized, double-blind, 2-by-2 factorial, placebo-controlled trial encompassing patients undergoing the TRA. Patients were randomized to either 500μg nitroglycerin or placebo; each arm was also subrandomized to early (upon sheath insertion) or late (right before sheath removal) nitroglycerin administration to evaluate the superiority of nitroglycerin in the prevention of RAO with 24 hours on Doppler ultrasound. A total of 2,040 patients were enrolled. RAO occurred in 49 patients (2.4%). Fifteen of these patients (30.6%) showed re-establishment of flow at 30days. Nitroglycerin, compared with placebo, did not reduce the risk for RAO at either of the 2 time points (early, 2.5% vs 2.3% [P=0.66]; late, 2.3% vs 2.5% [P=0.66]). By multivariable analysis, the presence of spasm (OR: 3.53; 95%CI: 1.87-6.65; P< 0.001) and access achieved with more than 1 puncture attempt (OR: 2.58; 95%CI: 1.43-4.66; P=0.002) were independent predictors of RAO. The routine use of nitroglycerin was not associated with a reduction in the rate of RAO, regardless ofthe time of administration (at the beginning or end of the TRA procedure).

COMPARISON OF INTRAVENOUS VERSUS INTR-ARTERIAL HEPARIN FOR THE PREVENTION OF RADIAL ARTERY OCCLUSION DURING TRANSRADIAL CORONARY ARTERY CATHETHERIZATION

Objective: To determine the relative efficacy of intravenous heparin as compared to intra-arterial heparin used during transradial coronary angiography for the prevention of radial artery occlusion.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Study was conducted at the Department of Cardiology, AFIC/NIHD Rawalpindi, Pakistan, from Jul 2019 to Dec 2019.&#x0D; Methodology: A total number of 144 patients were considered for the study using the consecutive sampling technique who were undergoing diagnostic coronary angiography. Patients were divided into the intra-arterial group (n=72) who received 50 IU/kg of unfractionated heparin (maximal dose 5,000 U) intra-arterially, and an intravenous group (n=72) received the similar dose through intravenous route. All patients were administered 100 mcg of nitroglycerin to minimize radial artery spasm. Coronary Angiography was performedusing a 6F introducer sheath and diagnostic catheters. Early radial artery occlusion (RAO) at 24 hours after the procedure was detected by performing the plethysmographic (reverse Barbeau’s) and doppler USG evaluation. Chronic RAO was assessed 30 days after the procedure by performing the same tests. Data was collected through a predesigned proforma and analyzed using SPSS 23. A p-value of less than 0.05 was considered as significant.&#x0D; Results: Early RAO was found in 4 (5.6%) of the patients from the intra-arterial groupand 5 (6.9%) of the intravenous group. The difference was found to be statistically insignificant (p-value 0.731). Chronic RAO was observed in 3 (4.4%) of the intra-arterial group as compared to 4 (6%) of the intravenous group. This difference was also statistically insignificant (p-value 0.683) for chronic RAO.&#x0D; Conclusion: Intra-arterial and intravenous heparin administration providedsimilar efficacy to prevent RAO.

Different dose of heparin in preventing radial artery occlusion after transradial coronary angiography: A protocol for systematic review and meta-analysis of randomized controlled trials.

Background:When atherosclerosis occurs in the coronary artery, resulting in stenosis, occlusion, or spasm of the coronary artery, the supply of blood and oxygen to the myocardium will be reduced or even unavailable, resulting in myocardial necrosis and heart pain, chest tightness, dyspnea and other symptoms caused by myocardial necrosis are collectively referred to as coronary atherosclerotic heart disease. Coronary angiography can not only understand the degree of coronary artery damage, but also estimate the prognosis of coronary artery stenting, which provides a reliable reference for clinical treatment. Transradial coronary angiography (TCA) has the advantages of high success rate, small trauma, less complications, no bed rest, reduce hospital stay and other superiority, which accepted and used by physicians. Although the success rate of surgery is high, the postoperative complications will still affect the effect of surgery and the prognosis of patients. The main manifestations are radial artery occlusion (RAO), forearm hematoma formation, pseudoaneurysm formation, periosteal compartment syndrome, radial artery perforation, etc. Among the many ways to prevent RAO, anticoagulant therapy with common heparin is one of them, but the dosage of heparin is not clear. Therefore, we decided to use systematic evaluation to evaluate the clinical effectiveness and safety of different dose of heparin in preventing of RAO, and to provide clinical basis for the early prevention and treatment of RAO.Methods:Two reviewers independently searched PubMed, Embase, the Cochrance Library, Web of Science, Medline, CBM Disc, CNKI, and WANFANG Data to find the eligible research. The retrieval about the randomized controlled trials of different dose of heparin in preventing the occurrence of RAO after TCA in recent years. The retrieval time is set between January 1990 and June 2020. The retrieval language is Chinese/English. Two researchers independently searched, managed and screened the literature through the search terms. When the 2 parties have inconsistent opinions on the inclusion or not of certain literature, the literature will be referred to the third researcher for discussion and decision. The included studies are conducted bias risk assessment through bias risk assessment tool, which based on Cochrane Handbook 5.0. The extracted data uses RevMan5.3 software for statistical processing.Results:The research results of this systematic review will be published in peer-reviewed medical-related academic journals.Conclusion:This study adopts the Meta-analysis method and expands the sample size, which will give high-quality evidence-based medicine evidence on the clinical effectiveness and safety of different dose of heparin in preventing the occurrence of RAO.Trial registration number:OSF, DOI 10.17605/OSF.IO/CPXJ3.

The Use of Acetylsalicylic Acid As A Measure of Prevention of Radial Artery Occlusion in Patients Who Perform Coronary Angiography with Tra Technique

Purpose: Τo investigate via ultrasound whether the prophylactic use of acetylsalicylic acid 9 days after coronary angiography with transradial access reduces the incidence of radial occlusion. Material and Methods: Between March 2016 to September 2017 we studied 100 patients (64 male, 36 females and mean age of 60.5 years) who underwent coronary angiography with transradial (TRA) access. Patients after coronary angiography were divided into 2 equal groups with similar characteristics (mean age, mean BMI) were the Group A received for 9 days acetylsalicylic acid 100 mg while the Group B was untreated. All patients were tested with Doppler ultrasound 1 month after coronary angiography. Statistical analysis was performed with SPSS (Version 25). Results: Statistical analysis of ultrasound data showed that there is a statistically significant difference between patients receiving acetylsalicylic acid as a precautionary measure for radial artery occlusion after catheterization for coronary angiography and non-treated patients X2 (2, N=100) 24.04, p < 0.05). Conclusion: The results of the study suggest that use of acetylsalicylic acid following coronary artery angiography with TRA technique may reduce the risk of the radial artery occlusion and its complications. Doppler ultrasound is an easy and reliable method for assessing the flow of the radial artery.

TCT-777 Prevention of Radial Artery Occlusion: Comparison of 3 Hemostatic Methods in Transradial Intervention

The main complication of transradial access (TRA) is radial artery occlusion (RAO). RAO is clinically relevant because it limits the radial approach for future coronary interventions and disables this conduit for coronary bypass grafting and arteriovenous fistulas. Strategies to prevent RAO are

Effects of methods used to achieve hemostasis on radial artery occlusion following percutaneous coronary procedures: a systematic review.

Transradial access to percutaneous coronary procedures is becoming the preferred access route, and it is being increasingly used for emergent and elective procedures. However, radial artery occlusion (RAO) continues to remain an adverse occurrence following sheath removal or in the first 24 hours following sheath removal due to the smaller diameter of the artery. The overall objective of this study was to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on RAO rates after percutaneous coronary procedures. The current review considered trials that included adult patients (18 years and over) who have had a coronary angiography or coronary re-vascularization intervention via the radial artery. The interventions of interest were the use of various hemostatic methods compared to traditional interventions to prevent RAO. All randomized and quasi-randomized controlled trials evaluating the effect of various hemostatic methods on RAO rates after percutaneous coronary procedures were included in the review. The primary outcome of interest was the incidence of RAO at the time of discharge and persistent occlusion at the time of follow-up. The search aimed to find published and unpublished trials through electronic databases, reference lists and key reports. An extensive search was undertaken for the following databases - CINAHL, Embase, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Databases were searched up to May 2016. The search for unpublished trials included Dissertation Abstracts International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and Theses and MedNar. Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Disagreements that arose between the reviewers were resolved through discussion. Quantitative data were extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-MAStARI. The data extracted were checked by a second reviewer. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry in Review Manager. Statistical pooling of the data was not possible due to the heterogeneity of the trials; therefore, the findings are presented in narrative form. However, figures have been used to illustrate the results. A total of seven trials were included in the review. One trial demonstrated a significant reduction in RAO rates in patients who had a mean arterial pressure (MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95% confidence interval [CI] 0.02, 0.37). A statistically significant reduction in the incidence of RAO was observed among patients who received a biopolymer dressing (Chitosen) compared to those who received the TR band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference in the incidence of RAO was reported between those who received the TR band and those who received either the elastic bandage (P = 0.08) or T band (P = 0.76). Similarly, no statistically significant difference in rates of RAO among patients was reported among those who had pro-coagulant dressings compared to those who had short or long manual compression. One trial that compared the TR band to a MAP-guided TR band demonstrated no statistically significant difference in the time taken to obtain hemostasis between the two groups (P = 0.61). A statistically significant reduction in the time taken to obtain hemostasis was observed among patients who received the hemostatic biopolymer dressing compared to the TR band. No statistically significant difference in the incidence of hematoma was identified among patients who received pneumatic compression or traditional compression to achieve hemostasis. There is limited evidence to support the use of any single hemostatic method to prevent RAO rates after percutaneous coronary procedures. Although used extensively, there is evidence of no effect of the pneumatic compression method using the TR band on the incidence of RAO at discharge or follow-up, the time taken to obtain hemostasis and the incidence of hematoma. The MAP-guided compression method and the Biopolymer dressing (Chitosen) were superior to the TR band compression method, and patent hemostasis was superior to hemoband in the prevention of RAO. However, these results are based on single trials and should be interpreted with caution. The evidence obtained from the review does not provide a concrete base for the development of practice guidelines. Until more robust evidence is available, practices will continue to be dictated by local preferences and available resources.

Effectiveness of enoxaparin for prevention of radial artery occlusion after transradial cardiac catheterization

The aim of this study was to assess the efficacy of enoxaparin for prevention of radial artery (RA) occlusion after transradial access for diagnostic and interventional cardiac procedures. RA occlusion is a potential complication of transradial cardiac catheterization. Conventionally, unfractionated heparin is used for prevention of RA occlusion. Effectiveness of low molecular weight heparins for prevention of this complication has not been tested before. Fifty transradial catheterizations were performed for diagnostic and/or interventional cardiac procedures in 39 patients. All the patients received 60 mg enoxaparin through the radial sheath at the beginning of the procedure for prevention of RA occlusion. RA patency was evaluated by Doppler examination. Patients were assessed for postprocedural RA occlusion at discharge and 5.5 +/- 2.8 days follow-up. RA occlusion was detected after 2 of the 50 transradial accesses, yielding a RA occlusion rate of % 4. In this study we found a low rate of RA occlusion with use of enoxaparin during transradial access. Enoxaparin is safe and effective in transradial procedures with a RA occlusion rate comparable to use of unfractionated heparin.