Incidence and predictors of forearm hematoma during the transradial approach for percutaneous coronary interventions

Abstract

Background The transradial approach for percutaneous coronary intervention (TRA-PCI) reduces vascular complications compared with the transfemoral approach (TFA). Although hematoma formation is less frequent with the TRA than TFA, it is not uncommon, and its presentation ranges from mild hematoma to compartment syndrome. Incidence and predictors of hematoma have not been well studied. Methods and results The present study was conducted to prospectively evaluate the incidence and predictors of forearm hematoma after TRA-PCI. The study population consisted of consecutive patients undergoing TRA-PCI. Baseline and procedural characteristics and clinical outcomes were prospectively collected. All patients were observed for forearm/arm hematoma immediately after procedure, after band removal, before discharge, and whenever the patient complained of pain/swelling in the limb. Logistic regression analysis was performed to determine the predictors for hematoma formation. A total of 520 patients who had successfully completed TRA-PCI were included in the final analysis. The mean age was 55.2 ± 9.5 years, and 24% patients were women. Hematoma occurred in 53 (10.2%) patients. Hematomas were of grade I, II, III, and IV in 22 (4.2%), 9 (1.7%), 18 (3.5%), and 4 (0.8%) patients, respectively. On multivariate logistic regression analysis, age, body mass index, multiple puncture attempt, glycoprotein IIb/IIIa receptor blocker use, nonclopidogrel agent use for dual antiplatelet therapy, and multiple catheter exchanges emerged as independent predictors for hematoma formation. Conclusions Forearm hematoma following TRA-PCI occurs in about 10% patients. Most hematomas occur near the puncture area. The independent predictors for hematoma formation are age, body mass index, multiple puncture attempts, intensive antiplatelet therapy, and multiple catheter exchanges.

Incidence and Risk Factors of Forearm Hematoma After Transradial Percutaneous Coronary Intervention

“…Another study reported similar results, that study reported advanced age, BMI, higher number of puncture attempts as risk factors of hematoma. 14 We did not found advance age as risk of hematoma formation.…”

“…This incidence is similar to the study of Garg et al reported hematoma formation in 10.2% patients after TRA-PCI and Bertrand et al who reported incidence of hematoma in 9.5% patients. 14,15 While some studies have reported lower incidence of hematoma, Hromádka et al and Susanu et al reported hematoma in 6.28% and 6.12% patients after TRA-PCI respectively. 16,17 The variation in incidence of hematoma may be due to diversity in definition to define hematoma in different studies, experience of interventionists and size of sheath used to vascular access.…”

Development of Compartment Syndrome after Radial Artery Puncture in a Patient with Acute Hypoxemic Respiratory Failure due to COVID-19

“…Pseudoaneurysms, arteriovenous fistulas, and hand ischemia are extremely rare [ 14 ]. In one case series of 520 patients undergoing transradial percutaneous coronary intervention, about 10% developed forearm hematomas; independent predictors of hematoma formation were age, body mass index, multiple puncture attempts, intensive antiplatelet therapy, and multiple catheter exchanges [ 15 ]. In another large case series from one hospital, the incidence of compartment syndrome was 0.004% or 2 out of 51,296 transradial cardiac catheterizations [ 16 ].…”

Safe and rapid radial hemostasis achieved using a novel topical hemostatic patch: Results of a first‐in‐human pilot study using hydrophobically modified polysaccharide‐chitosan

“…Garg et al similarly demonstrated that low BMI was an independent predictor of postprocedure bleeding complications in a prospective analysis of more than 500 patients who underwent TRA PCI. 35 It seems plausible that the novel hm-P patch functions via accelerating superficial hemostasis from the skin surface along the tract of the sheath while the pneumatic compression device works by stabilizing the vessel and compressing the deeper soft tissue around the vessel, above the boney structure of the distal forearm. Our study suggests that hm-P can lead to more reliable hemostasis and obviate compression device retightening which has also been independently associated with subsequent RAO.…”