Comparison of low dose versus standard dose heparin for radial approach in elective coronary angiography?

Aykan, Ahmet Çağrı; Gökdeniz, Tayyar; Gül, İlker; Kalaycıoğlu, Ezgi; Çetin, Mustafa; Hatem, Engin; Çavuşoğlu, İsmail Gökhan; Karabay, Can Yücel; Güler, Ahmet; Aykan, Duygun Altıntaş; Yıldız, Mustafa

doi:10.1016/j.ijcard.2015.03.314

Cited by 32 publications

(37 citation statements)

References 14 publications

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“…Recent publications confirm the difficult challenge encountered by the transradial interventionalists to maintain postprocedural forearm artery patency with ranging frequencies between 9.24% of ultrasonography‐detected late RAOs using the patent hemostasis technique (56 of 606 patients) and 25% of clinically detected RAOs with low‐dose heparin . Analysis of observational studies showed a benefit of higher heparin dose in terms of forearm artery patency, which was also confirmed after analyzing 5 small randomized, controlled trials specifically designed to address this issue. We found no geographical disparity of RAO/UAO frequency.…”

Section: Discussionmentioning

confidence: 69%

“…In 1 report, a 1% reduction of RAO per 1‐IU/kg heparin dose increase has been suggested . Randomized, control trials and pooled 1‐center data have indicated some benefit of “standard” (ie, 5000 IU) over low (ie, usually 2000–2500 IU) heparin dose, but have been inconclusive because of inadequate statistical power . By considering both observational reports and randomized studies, this meta‐analysis elucidates the advantage of higher anticoagulation intensity.…”

Section: Discussionmentioning

confidence: 94%

“…In observational studies, several independent risk factors for RAO have been identified; yet anticoagulation appeared only inconsistently to predict RAO . In 1 report, a 1% reduction of RAO per 1‐IU/kg heparin dose increase has been suggested .…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 94%

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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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“…RAO is a thrombotic process that begins during the hemostasis process . Use of heparin (50 U/kg or 5,000 u) has been shown to prevent RAO . Nearly, all respondents gave some anticoagulation for diagnostic procedures.…”

Section: Discussionmentioning

confidence: 99%

Contemporary transradial access practices: Results of the second international survey

Shroff

Fernandez

Vidovich

et al. 2018

Cathet Cardio Intervent

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Objectives To gain insight into current practice of transradial angiography and intervention in the United States and around the world. Background Transradial access (TRA) has grown worldwide. In a prior survey, there was significant practice variation and there was minimal US participation which limited the generalizability to US operators. Methods We used an internet‐based survey software program to solicit input from practicing interventional cardiologists from the United States and around the world. US operators were compared with outside the United States (OUS) operators and respondent‐level comparisons were made with the prior survey to assess for temporal changes in practice. Results Between August 2016 and January 1, 2017, 125 interventional cardiologists completed the survey representing 91 countries with the United States having 449 (39.9%) respondents. Preprocedure, noninvasive testing for collateral circulation is used more commonly in the United States (54.1%) than around the world (26.6%) but its use has decreased since 2010. In the US, 48.8% of operators never use ultrasound and 92.6% of OUS operators never use it; only 4.4% overall use ultrasound in >50% of cases. Use of bivalirudin has decreased in the US and OUS. Nearly, 30% of operators do not assess for radial artery patency following hemostasis. US respondents used TRA less commonly for primary PCI for STEMI than their global counterparts. Conclusions There is wide variation in how TRA procedures are performed including relatively low rates of adherence to practices that are known to improve outcomes. Further education aimed at increasing use of best practices will impact patient outcomes.

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“…Over the last decade, multiple measures have been advocated to mitigate the risk of RAO, including limiting the number of times the same radial artery is accessed, reducing radial artery spasm, use of small diameter and hydrophilic arterial sheaths, implementing a non‐occlusive (“patent”) hemostasis technique, ulnar artery compression, and administering periprocedural anticoagulants . Historically, unfractionated heparin (UFH) has been used with the expectation that it would minimize the occurrence of RAO .…”

Section: Introductionmentioning

confidence: 99%

Heparin use for diagnostic cardiac catheterization with a radial artery approach: An international survey of practice patterns

Bossard

Lavi

Rao

et al. 2018

Cathet Cardio Intervent

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Comparison of low dose versus standard dose heparin for radial approach in elective coronary angiography?

Cited by 32 publications

References 14 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

Contemporary transradial access practices: Results of the second international survey

Heparin use for diagnostic cardiac catheterization with a radial artery approach: An international survey of practice patterns

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