Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case–control study

Abstract

BackgroundRadial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail.AimThe objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization.Patients and methodsOverall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination.ResultsEight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229).ConclusionRAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.

Novel oral anticoagulants in the treatment of radial artery occlusion

“…In addition, novel oral anticoagulants have been approved for venous thromboembolism therapy, though the precise duration of treatment remains debatable. Although a three‐month course of novel oral anticoagulation has been suggested for venous thromboembolism, and up to a 90‐day course of these medications has been trialed anecdotally to treat post‐cardiac catheterization RAO, 15 in this case series of RAO, a 30 day course of apixaban demonstrated efficacy in our experience.…”

“…There has been limited investigation into the potential impact of novel oral anticoagulants in the treatment of RAO. In subgroup analysis of one study, there were a total of 17 cases of RAO treated with anticoagulation, either with low‐molecular‐weight heparin (10 cases), apixaban (one case), or rivaroxaban (six cases) 15 . The conclusions suggest that anticoagulation is effective in improving the patency rates following RAO, but there is no delineation of specifically which anticoagulation strategies were effective.…”

“…In subgroup analysis of one study, there were a total of 17 cases of RAO treated with anticoagulation, either with low-molecular-weight heparin (10 cases), apixaban (one case), or rivaroxaban (six cases). 15 The conclusions suggest that anticoagulation is effective in improving the patency rates following RAO, but there is no delineation of specifically which anticoagulation strategies were effective. In addition, novel oral anticoagulants have been approved for venous thromboembolism therapy, though the precise duration of treatment remains debatable.…”

Radial artery occlusion after cardiac catheterization and impact of medical treatment

“…One study addressed the treatment of symptomatic RAO and found that low molecular heparin may lead to partial or complete reopening in almost 80% within 4 weeks of treatment [8]. In another study, 15 patients with asymptomatic RAO were treated and a similar percentage of patients who continued treatment for more than 4 weeks regained patency [5].…”

“…In clinical practice, time-limited empirical medical regimens are used in order to restore patency and perfusion. A recent study by our team has investigated the benefits of anticoagulation in a small prospective study [5].…”