Wright Center for Graduate Medical Education and Commonwealth Medical College, Scranton, Pennsylvania, USA.
Am J Cardiol. 2012 Jul 15;110(2):173-6. doi: 10.1016/j.amjcard.2012.03.007. Epub 2012 Apr 10.
Systemic anticoagulation decreases the risk of radial artery occlusion (RAO) after transradial catheterization and standard occlusive hemostasis. We compared the efficacy and safety of provisional heparin use only when the technique of patent hemostasis was not achievable to standard a priori heparin administration after radial sheath introduction. Patients referred for coronary angiography were randomized in 2 groups. In the a priori group, 200 patients received intravenous heparin (50 IU/kg) immediately after sheath insertion. In the provisional group, 200 patients did not receive heparin during the procedure. After sheath removal, hemostasis was obtained using a TR band (Terumo corporation, Tokyo, Japan) with a plethysmography-guided patent hemostasis technique. In the provisional group, no heparin was given if radial artery patency could be obtained and maintained. If radial patency was not achieved, a bolus of heparin (50 IU/kg) was given. Radial artery patency was evaluated at 24 hours (early RAO) and 30 days after the procedure (late RAO) by plethysmography. Patent hemostasis was obtained in 67% in the a priori group and 74% in the provisional group (p = 0.10). Incidence of RAO remained similar in the 2 groups at the early (7.5% vs 7.0%, p = 0.84) and late (4.5% vs 5.0%, p = 0.83) evaluations. Women, patients with diabetes, patients having not received heparin, and patients without radial artery patency during hemostasis had more RAO. By multivariate analysis, patent radial artery during hemostasis (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.004 to 0.28, p = 0.002) and diabetes (OR 11, 95% CI 3 to 38,p <0.0001) were independent predictors of late RAO, whereas heparin was not (OR 0.45 95% CI 0.13 to 1.54, p = 0.20). In conclusion, our results suggest that maintenance of radial artery patency during hemostasis is the most important parameter to decrease the risk of RAO. In selected cases, provisional use of heparin appears feasible and safe when patent hemostasis is maintained.
系统抗凝可降低经桡动脉穿刺后桡动脉闭塞（RAO）的风险和标准闭塞止血。我们比较了仅在无法实现专利止血技术时临时使用肝素与标准预先给予肝素后，对桡动脉鞘管置入后的疗效和安全性。将行冠状动脉造影的患者随机分为 2 组。在预先组，200 例患者在鞘管插入后立即接受静脉肝素（50IU/kg）。在临时组，200 例患者在手术过程中未接受肝素。鞘管取出后，使用脉搏体积描记仪引导的专利止血技术，用 TR 带（日本东京 Terumo 公司）获得止血。在临时组，如果可以获得并维持桡动脉通畅，则不给予肝素。如果桡动脉未通畅，则给予肝素（50IU/kg）推注。在 24 小时（早期 RAO）和术后 30 天（晚期 RAO）通过脉搏体积描记术评估桡动脉通畅性。预先组的专利止血成功率为 67%，临时组为 74%（p=0.10）。两组在早期（7.5%vs7.0%，p=0.84）和晚期（4.5%vs5.0%，p=0.83）评估时，RAO 的发生率相似。女性、糖尿病患者、未接受肝素治疗的患者以及止血期间桡动脉不通畅的患者 RAO 更多。多变量分析显示，止血时桡动脉通畅（比值比[OR]0.03，95%置信区间[CI]0.004 至 0.28，p=0.002）和糖尿病（OR 11，95%CI3 至 38，p<0.0001）是晚期 RAO 的独立预测因子，而肝素不是（OR 0.45，95%CI0.13 至 1.54，p=0.20）。总之，我们的结果表明，止血期间保持桡动脉通畅是降低 RAO 风险的最重要参数。在选定的情况下，当专利止血得以维持时，临时使用肝素是可行且安全的。
