Division of Cardiology, Ospedale Civile, Mirano, Italy.
Division of Cardiology, Department of Medicine, Università di Verona, Verona, Italy.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):1369-1376. doi: 10.1002/ccd.29066. Epub 2020 Jun 17.
To assess the independent predictors of patent and occlusive hemostasis (PH and OH, respectively) during radial hemostasis after coronary procedures.
Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, inadequate, and excessive anticoagulation are all predictors of RAO.
As a part of a previously published study investigating the relationship between residual anticoagulation and risk of RAO, 837 patients undergoing transradial diagnostic coronary angiography or percutaneous coronary interventions were enrolled. Cumulative heparin dose used during the procedure and ACT measured before sheath removal were recorded. PH with reverse Barbeau test was attempted in all patients (NCT02762344).
PH was less frequently obtained for increasing cumulative heparin dose and ACT values (p < .0001 and p = .0034, respectively). At logistic regression analysis both cumulative heparin dose and ACT values were independent predictors of OH (OR 1.017, 95% IC 1.011-1.023 p < .0001 and OR 1.004, 95% IC 1.001-1.006, p = .0004) while adjusted probability for RAO showed exponential relationship with both parameters.
The level of anticoagulation is strongly related to the incidence of RAO, and should be taken into account when choosing hemostasis protocol.
评估经皮冠状动脉介入治疗后桡动脉止血时出现通畅性和闭塞性止血（分别为 PH 和 OH）的独立预测因素。
桡动脉闭塞（RAO）是经桡动脉穿刺的血栓并发症，可导致桡动脉永久性闭塞。鞘管血管直径比、术后压迫时间、闭塞性止血、抗凝不足和过度都是 RAO 的预测因素。
作为一项先前发表的研究的一部分，该研究调查了残余抗凝与 RAO 风险之间的关系，共纳入了 837 例行经桡动脉诊断性冠状动脉造影或经皮冠状动脉介入治疗的患者。记录术中使用的累积肝素剂量和拔鞘前测量的 ACT。对所有患者尝试进行反向 Barbeau 试验以获得 PH（NCT02762344）。
随着累积肝素剂量和 ACT 值的增加，PH 的获得频率降低（p<0.0001 和 p=0.0034）。在逻辑回归分析中，累积肝素剂量和 ACT 值都是 OH 的独立预测因素（OR 1.017，95%CI 1.011-1.023，p<0.0001 和 OR 1.004，95%CI 1.001-1.006，p=0.0004），而调整后的 RAO 概率与这两个参数呈指数关系。
抗凝水平与 RAO 的发生率密切相关，在选择止血方案时应考虑到这一点。
