Author + information
- Khagendra Dahala,b,
- Sharan Sharmaa,b,
- Jagan Beedupallia,b,
- Juyong Leea,b,
- Enrique Jimeneza,b,
- Kalgi Modia,b and
- Neeraj Tandona,b
Background: Transradial access (TRA), compared to femoral access, is preferred for coronary procedures due to reduced access-related bleeding and mortality. Radial artery occlusion (RAO) is a known complication of TRA, and precludes its use as a future access site, conduit for CABG or for hemodialysis fistula placement. Although heparin 5000 Units is used as a standard dose (SD) during TRA, the risks of RAO and hematoma compared to lower dose (LD) remains unclear. To compare the risks of RAO and hematoma using SD vs. LD heparin after coronary angiography (CA) through TRA, we performed a meta-analysis of randomized controlled trials (RCT).
Methods: We searched PubMed, EMBASE, CINAHL and CENTRAL for RCTs since inception through October 13, 2016 and used random effects model for analysis. The outcomes analyzed were RAO, hematoma and radial artery compression time (RACT).
Results: We identified a total of 6 RCTs with a total of 2239 patients (SD=1141 & LD=1098). SD heparin resulted in a trend toward lower risk of RAO [5.3% vs. 7.7%; risk ratio (RR): 0.65, 95% confidence interval (CI): 0.38-1.12; P=0.12], higher risk of hematoma [3.66% vs. 1.5%; 2.10 (1.05-4.20); P=0.04], and a strong trend toward longer RACT [mean difference: 13.12 (-0.08, 26.31); P=0.05)] compared to LD.
Conclusions: In the current study, SD heparin showed a trend toward lower risk of RAO and higher risk of hematoma during CA through radial access. Larger trials are needed to find the appropriate dose of heparin in these settings.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Vascular Access and Hemostasis Issues
Abstract Category: 26. Interventional Cardiology: Vascular Access and Complications
Presentation Number: 1192-118
- 2017 American College of Cardiology Foundation