Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention

Abstract

Background Radial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion ( RAO ) but might be associated with incomplete hemostasis. Methods and Results In total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20‐ and 60‐minute clamp application groups, respectively ( P =0.19). The incidence of grade 1 hematoma was higher in the 20‐minute group (6.7% versus 2.5%, P =0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20‐ and 60‐minute groups, respectively ( P =0.36). Requirement for clamp retightening (36% versus 16%, P =0.01) was higher among patients who had RAO . Need for clamp retightening was the only independent predictor of RAO ( P =0.04). Conclusions Ultrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60‐minute clamp duration is safe and provides good access site hemostasis with low RAO rates. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02269722.

Ankaferd blood stopper as a new strategy to avoid early complications after transradial procedures: A randomized clinical trial

“…In our conventional patent hemostasis with TR Band hemostasis failure was 27.31%, and the ABS group had approximately three times less bleeding rate (9.40%, P < 0,001) compared to the other two groups. Since re‐bleeding/compression regarded as a manageable issue and its incidence ranges from 1% to 18.4% with conventional patent hemostasis, 9.40% re‐bleeding with ABS seems highly acceptable considering the 0% RAO rate achieved in short and long term. Besides, knowing the predictors of bleeding we may have the chance to further decrease the re‐bleeding rate with ABS by simply increasing the compression time a bit in this risky population.…”

Radial hemostasis: Harder, better, faster, stronger?

“…However, there is no consensus on the duration of compression needed, with practices ranging from as few as 60 min to as long as 6 hr as practiced in Japan. Longer compression time is associated with increased RAO occlusion rates and likely greater observation costs, while <60 min of compression has been associated with increased hematoma rates …”

“…In the absence of hemostatic agents, very short (20 min) compression times have higher rates of hematoma formation, increased need for recompression, and increased rates of RAO compared with 60 min . Nevertheless, the drive for more efficient radial hemostasis will continue to test the lower limits of compression time.…”

Radial versus femoral approach for same‐day inter‐facility transfer for percutaneous coronary intervention

“…After completion of the transradial procedure, the sheath was removed, and a hemostatic wristband applied for 1-hr carefully achieving patent hemostasis. 12 For transfemoral patients, the sheath was removed in the cath lab followed by a closure device insertion or by manual compression in the holding room after achieving an activated clotting time less than 160 sec. Most patients were then kept in hospital overnight, and in selected cases, patients were dischargedhome 3-4 hr post-PCI.…”