Dwivedi Sudhanshu Kumar, Nayak Gyanaranjan, Sharma Akhil Kumar, Chaudhary Gaurav Kumar, Chandra Sharad, Bhandari Monika, Vishwakarma Pravesh, Pradhan Akshyaya, Sethi Rishi, Narain Varun Shankar
Department of Cardiology, King George's Medical University Lucknow, Uttar Pradesh 226003, India.
Am J Cardiovasc Dis. 2021 Aug 15;11(4):462-470. eCollection 2021.
Forearm hematomas are not uncommon after transradial coronary interventions. The present study describes the incidence and predictors of forearm hematoma formation after transradial coronary interventions.
This was a prospective study in 1754 patients undergoing angiography/angioplasty through transradial access. Each procedure was performed using optimum levels of anticoagulation, hydrophilic sheaths, and post-procedural patent hemostasis protocols. Patients were evaluated for forearm hematoma immediately after the procedure, after radial band removal, and on the next day of the procedure. Severity of hematomas was graded according to the Early Discharge after Transradial Stenting of Coronary Arteries Study scale. Univariate and multivariate logistic regression analyses were done to determine the predictors of hematoma formation.
Mean age of the patients was 56.31 years and 82.2% were males. A total of 1374 (78.3%) patients underwent angioplasty while 380 (21.7%) underwent angiography. Forearm hematoma developed in 187 (10.7%) patients. Grade I hematoma was most common (3.53%) followed by Grade II (3.08%), Grade III (2.83%) and Grade IV (1.25%) hematoma. None of the patients required vascular or surgical interventions for this complication. Female gender, multiple puncture attempts, intensive antiplatelet therapy, complex procedure and longer hemostasis time were significant predictors of forearm hematoma formation post transradial coronary interventions.
Forearm hematoma developed in substantial proportion of patients undergoing transradial coronary interventions and interventional variables were predominantly associated with hematoma formation. Pre-emptive knowledge of modifiable interventional risk factors can help in reducing the burden of this complication.
经桡动脉冠状动脉介入术后，前臂血肿并不少见。本研究描述了经桡动脉冠状动脉介入术后前臂血肿形成的发生率及预测因素。
这是一项对1754例经桡动脉途径进行血管造影/血管成形术患者的前瞻性研究。每项操作均采用最佳水平的抗凝、亲水鞘管及术后有效的止血方案。术后即刻、拆除桡动脉压迫带后及术后次日对患者进行前臂血肿评估。根据冠状动脉经桡动脉支架置入术后早期出院研究量表对血肿严重程度进行分级。采用单因素和多因素逻辑回归分析确定血肿形成的预测因素。
患者的平均年龄为56.31岁，男性占82.2%。共有1374例（78.3%）患者接受了血管成形术，380例（21.7%）接受了血管造影。187例（10.7%）患者发生前臂血肿。I级血肿最为常见（3.53%），其次是II级（3.08%）、III级（2.83%）和IV级（1.25%）血肿。无一例患者因该并发症需要血管或外科干预。女性、多次穿刺尝试、强化抗血小板治疗、复杂操作及更长的止血时间是经桡动脉冠状动脉介入术后前臂血肿形成的显著预测因素。
相当比例的经桡动脉冠状动脉介入术患者发生前臂血肿，介入变量主要与血肿形成相关。对可改变的介入危险因素的预先了解有助于减轻该并发症的负担。
