The Wright Center for Graduate Medical Education and The Commonwealth Medical College, Scranton, Pennsylvania.
The Wright Center for Graduate Medical Education and The Commonwealth Medical College, Scranton, Pennsylvania.
Am J Cardiol. 2014 Jan 15;113(2):211-4. doi: 10.1016/j.amjcard.2013.09.043. Epub 2013 Oct 5.
The efficacy of warfarin-induced anticoagulation in reducing radial artery occlusion (RAO) after transradial access is not known. The present case-control study compared the incidence of early (24 hours) and late (30 days) RAO in patients undergoing transradial diagnostic coronary angiography during therapeutic warfarin anticoagulation (group 1) with that of a matched (3:1) cohort of patients not receiving warfarin and receiving intraprocedural heparin (group 2). All patients underwent transradial diagnostic coronary angiography using a 5F hydrophilic introducer sheath. The patients in group 2 received an intravenous heparin bolus (50 IU/kg) immediately after sheath insertion. After sheath removal, hemostasis was obtained using the TR-band (Terumo Interventional Systems, Terumo Medical, Tokyo, Japan) and a plethysmography-guided patent hemostasis technique. We included 86 patients receiving warfarin with an international normalized ratio of 2 to 4 in group 1 and 250 matched patients in group 2. No significant differences were present in the demographic and procedural variables between the 2 groups. Early RAO occurred in 18.6% of the patients in group 1 compared with 9.6% of patients in group 2 (p = 0.024). The incidence of late RAO remained significantly higher in group 1 compared with group 2 (13.9% vs 5.2%, p = 0.01). All patients with RAO remained asymptomatic. In conclusion, patients receiving chronic oral anticoagulation with warfarin and undergoing transradial coronary angiography without parenteral anticoagulation had a higher incidence of early and late RAO compared with patients receiving standard intravenous heparin therapy.
在经桡动脉入路后，华法林诱导的抗凝治疗对减少桡动脉闭塞（RAO）的疗效尚不清楚。本病例对照研究比较了接受经桡动脉诊断性冠状动脉造影的患者（治疗性华法林抗凝组，组 1）与未接受华法林且接受术中肝素治疗的患者（接受经桡动脉诊断性冠状动脉造影的患者，3:1 匹配组，组 2）中早期（24 小时）和晚期（30 天）RAO 的发生率。所有患者均采用 5F 亲水引导鞘进行经桡动脉诊断性冠状动脉造影。组 2 患者在插入鞘后立即给予静脉肝素推注（50IU/kg）。鞘取出后，使用 TR 带（Terumo Interventional Systems，Terumo Medical，Tokyo，Japan）和基于体积描记法的专利止血技术进行止血。我们纳入了组 1 中接受华法林治疗且国际标准化比值为 2 至 4 的 86 例患者和组 2 中 250 例匹配患者。两组患者的人口统计学和手术变量无显著差异。组 1 中有 18.6%的患者发生早期 RAO，而组 2 中有 9.6%的患者发生早期 RAO（p=0.024）。组 1 中晚期 RAO 的发生率仍明显高于组 2（13.9%vs.5.2%，p=0.01）。所有发生 RAO 的患者均无症状。结论：与接受标准静脉肝素治疗的患者相比，接受华法林长期口服抗凝治疗且未接受静脉抗凝治疗的患者发生早期和晚期 RAO 的发生率更高。
