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Lee VK, Lee T, Ghosh A, Saha T, Bais MV, Bharani KK, Chag M, Parikh K, Bhatt P, Namgung B, Venkataramanan G, Agrawal A, Sonaje K, Mavely L, Sengupta S, Mashelkar RA, Jang HL. An architecturally rational hemostat for rapid stopping of massive bleeding on anticoagulation therapy. Proc Natl Acad Sci U S A 2024; 121:e2316170121. [PMID: 38252814 PMCID: PMC10835033 DOI: 10.1073/pnas.2316170121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
Hemostatic devices are critical for managing emergent severe bleeding. With the increased use of anticoagulant therapy, there is a need for next-generation hemostats. We rationalized that a hemostat with an architecture designed to increase contact with blood, and engineered from a material that activates a distinct and undrugged coagulation pathway can address the emerging need. Inspired by lung alveolar architecture, here, we describe the engineering of a next-generation single-phase chitosan hemostat with a tortuous spherical microporous design that enables rapid blood absorption and concentrated platelets and fibrin microthrombi in localized regions, a phenomenon less observed with other classical hemostats without structural optimization. The interaction between blood components and the porous hemostat was further amplified based on the charged surface of chitosan. Contrary to the dogma that chitosan does not directly affect physiological clotting mechanism, the hemostat induced coagulation via a direct activation of platelet Toll-like receptor 2. Our engineered porous hemostat effectively stopped the bleeding from murine liver wounds, swine liver and carotid artery injuries, and the human radial artery puncture site within a few minutes with significantly reduced blood loss, even under the anticoagulant treatment. The integration of engineering design principles with an understanding of the molecular mechanisms can lead to hemostats with improved functions to address emerging medical needs.
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Affiliation(s)
- Vivian K. Lee
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Taewoo Lee
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Amrit Ghosh
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Tanmoy Saha
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Manish V. Bais
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Translational Dental Medicine, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA02118
| | - Kala Kumar Bharani
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Science, P. V. Narasimha Rao Telangana Veterinary University, Hyderabad 500030, India
| | - Milan Chag
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Keyur Parikh
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Parloop Bhatt
- Care Institute of Medical Sciences, Ahmedabad 380060, India
| | - Bumseok Namgung
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Geethapriya Venkataramanan
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | | | - Kiran Sonaje
- Axio Biosolutions Private Limited, Ahmedabad 382220, India
| | - Leo Mavely
- Axio Biosolutions Private Limited, Ahmedabad 382220, India
- Advamedica Inc., Boston, MA 02138
| | - Shiladitya Sengupta
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Health Sciences and Technology, Harvard–Massachusetts Institute of Technology, Massachusetts Institute of Technology, Cambridge, MA 02139
| | | | - Hae Lin Jang
- Center for Engineered Therapeutics, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115
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Inanc IH, Mutlu D, Efe ZN, Kulaksızoglu S, Marmagkiolis K, Iliescu C, Ates I, Feldman MD, Cilingiroglu M. Open Radial Artery Study. Am J Cardiol 2024; 211:130-136. [PMID: 38035500 DOI: 10.1016/j.amjcard.2023.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 12/02/2023]
Abstract
Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still lacking. In our study, we aimed to evaluate the effect of patent hemostasis on early (24 hours) and late (2 weeks) RAO prevention. The Open Radial Artery Study was a single-arm, prospective, and multicenter study. The primary end points were early and late RAO at the vascular access site after transradial coronary procedures. Secondary end points were access site hematoma, pseudoaneurysm formation, arteriovenous fistula, and nerve injury. A total of 2,181 patients were analyzed (67% male, mean age 68 years). The mean interventional duration and hemostatic times were 75.6 ± 55.6 and 60 ± 5.6 minutes, respectively. Radial artery spasm occurred in 10% of patients (n = 218). Catheter kinking, radial artery rupture, or dissection were not observed during the procedure. RAO, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve damage was not observed in any of the patients in the early or late period. In patients who undergo coronary diagnostic or interventional procedures through transradial artery access, the patent hemostasis method seems a critical step in the prevention of early and late RAO.
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Affiliation(s)
- Ibrahim H Inanc
- Department of Cardiology, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey
| | - Deniz Mutlu
- Minneapolis Heart Institute Foundation, Center for Coronary Artery Disease, Minneapolis, MN, USA; Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Zeynep N Efe
- Department of Cardiology, Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California
| | - Sibel Kulaksızoglu
- Department of Medical Biochemistry, Antalya Education and Research Hospital, Antalya, Turkey
| | - Kostas Marmagkiolis
- Tampa General Hospital, University of South Florida, Tampa, Florida; Tampa General Hospital, University of South Florida, Tampa, Florida
| | - Cezar Iliescu
- MD Anderson Cancer Center, University of Texas in Houston, Houston, Texas
| | - Ismail Ates
- Department of Cardiology, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Marc D Feldman
- Department of Cardiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Mehmet Cilingiroglu
- MD Anderson Cancer Center, University of Texas in Houston, Houston, Texas; Department of Cardiology, University of Texas Health San Antonio, San Antonio, Texas.
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Kheirabad MK, Mohebbi Z, Kalyani MN, Kojuri J. Vascular outcomes of early deflation of radial artery band following coronary angiography: A controlled clinical trial. JOURNAL OF VASCULAR NURSING 2023; 41:56-61. [PMID: 37356871 DOI: 10.1016/j.jvn.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 06/27/2023]
Abstract
The present study aimed to investigate the effect of early deflation of the transradial (TR) band on the vascular outcomes of patients who have undergone coronary angiography through transradial access (TRA). The present controlled clinical trial included all patients who had undergone elective coronary angiography through TRA. The participants (n=70) met the inclusion criteria and were selected using convenient sampling. Then, they were randomly assigned to the intervention and control groups, using block randomization. Data collection tools included a questionnaire on demographic and related clinical data, including the history of diabetes, hypertension, hypercholesterolemia, heart failure and vascular disease, and the checklist of post-angiographic complications, including duration of the procedure, systolic and diastolic blood pressures measured before and after the procedure, and assessments of radial artery occlusion (RAO), hematoma and pain. The intervention group had their TR band on the artery for 1.5 hours after the procedure. Then, the cuff of the band was deflated at a speed of 5 cc every 15 minutes, using a syringe. However, the TR band was kept in place for 2 hours in the control group, followed by the deflation with the same speed. The pressure application time was recorded in both groups from the removal of sheaths until complete hemostasis. The patients with early deflation of the TR band experienced less pain compared to those with typical deflation (P=0.003). However, the variables of hematoma development (P=0.062) and RAO (P=0.371) were not significantly different between the patients with typical and early deflation of the TR band. The present study concluded that the patients with early deflation of the TR band experienced less pain compared to those with typical deflation. Therefore, deflating the TR band after cardiac angiography at 1,5 hours has similar efficacy and safety compare to 2 hours and associated with less reported pain score.
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Affiliation(s)
- Marjan Karami Kheirabad
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinat Mohebbi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Majid Najafi Kalyani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Minici R, Serra R, Maglia C, Guzzardi G, Spinetta M, Fontana F, Venturini M, Laganà D. Efficacy and Safety of Axiostat ® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers. J Pers Med 2023; 13:jpm13050812. [PMID: 37240982 DOI: 10.3390/jpm13050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. METHODS This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. RESULTS Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. CONCLUSIONS Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4-8 Fr introducer sheath.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Claudio Maglia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Bardooli F, Kumar D. Do We Still Need to Assess Post-procedural Radial Artery Compression Time and Radial Artery Occlusion in Patients Who Undergo Transradial Coronary Intervention? Cureus 2023; 15:e35129. [PMID: 36945287 PMCID: PMC10025872 DOI: 10.7759/cureus.35129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Background and objective Transradial access (TRA) for interventional coronary procedures has now been widely accepted as the preferred vascular site approach. The duration of post-procedure compression has been shown to be a crucial factor and different hemostatic devices used in this regard have been compared. In this study, we aimed to compare the post-procedure compression time, radial artery occlusion (RAO), hematoma, and bleeding between the transradial (TR) band and AIR band for radial artery patency among patients presenting at a tertiary care hospital. Methodology This observational study was conducted at the Department of Cardiology of Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre, Awali, Bahrain from 06/03/2022 to 05/06/2022. The research involved patients of either gender who had a positive Barbeau test (type A to C) and were receiving percutaneous coronary intervention via a transradial route. Patients who underwent transradial coronary intervention were classified into two separate groups, depending on whether an AIR band (group A) or a TR band (group B) compression was used. Following coronary catheterization, radial hemostatic compression devices were used. The results were documented both during and after the hemostatic compression. The data were analyzed using IBM SPSS Statistics version 23 (IBM Corp., Armonk, NY). Results Of the total 100 patients included in the study, the majority were males (86%) and aged more than 50 years (83%). AIR band was successfully removed in 32 patients (64%) in less than four hours, compared to the TR band, which was removed in less than four hours in two patients (4%) only (p=0.001). The incidences of bleeding (p=0.790) and RAO (p=0.495) were similar between the AIR band group and the TR band group. Hematoma was not seen in any of the patients in either group. Conclusion AIR band was observed to be more efficacious in decreasing the radial artery compression time. However, the difference in RAO was insignificant in the short term, and follow-up studies are required to see if the AIR band is associated with any long-term benefits.
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Affiliation(s)
- Fawaz Bardooli
- Interventional Cardiology, Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre, Awali, BHR
| | - Dileep Kumar
- Cardiology, Mohammed Bin Khalifa Bin Sulman Al Khalifa Specialist Cardiac Centre, Awali, BHR
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Comparison of Safety of RADial comPRESSion Devices: A Multi-Center Trial of Patent Hemostasis following Percutaneous Coronary Intervention from Conventional Radial Access (RAD-PRESS Trial). Diagnostics (Basel) 2023; 13:diagnostics13010143. [PMID: 36611435 PMCID: PMC9818930 DOI: 10.3390/diagnostics13010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Although radial access is the current gold standard for the implementation of percutaneous coronary interventions (PCI), post-procedural radial compression devices are seldom compared with each other in terms of safety or efficacy. Our group aimed to compare a cost effective and potentially green method to dedicated radial compression devices, with respect to access site complications combined in a device oriented complex endpoint (DOCE), freedom from which served as our primary endpoint. Patients undergoing PCI were randomized to receive either the cost effective or a dedicated device, either of which were removed using patent hemostasis. Twenty-four hours after the procedure, radial artery ultrasonography was performed to evaluate the access site. The primary endpoint was assessed using a non-inferiority framework with a non-inferiority margin of five percentage points, which was considered as the least clinically meaningful difference. The cost-effective technique and the dedicated devices were associated with a comparably low rate of complications (freedom from DOCE: 83.3% vs. 70.8%, absolute risk difference: 12.5%, one-sided 95% confidence interval (CI): 1.11%). Composition of the DOCE (i.e., no complication, hematoma, pseudoaneurysm, and radial artery occlusion) and compression time were also assessed in superiority tests as secondary endpoints. Both the cost-effective technique and the dedicated devices were associated with comparably low rates of complications: p = 0.1289. All radial compression devices performed similarly when considering the time to complete removal of the respective device (120.0 (inter-quartile range: 100.0-142.5) for the vial vs. 120.0 (inter-quartile range: 110.0-180) for the dedicated device arm, with a median difference of [95% CI]: 7.0 [-23.11 to 2.00] min, p = 0.2816). In conclusion, our cost-effective method was found to be non-inferior to the dedicated devices with respect to safety, therefore it is a safe alternative to dedicated radial compression devices, as well as seeming to be similarly effective.
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Luo YG, Zhang XW, Tsauo JW, Li Y, Li JG, Peng Q, Li YW, Sun W, Zhao H, Li X. Modified Patent Hemostasis Strategy Based on the Platelet Counts for Transradial Access Chemoembolization in Patients with Hepatocellular Carcinoma: A Prospective Single-Center Study. J Hepatocell Carcinoma 2023; 10:687-695. [PMID: 37113465 PMCID: PMC10128083 DOI: 10.2147/jhc.s410952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Objective This study aimed to investigate the shortest compression time to achieve hemostasis and the optimal hemostasis strategy in patients treated with transradial access chemoembolization (TRA-TACE). Methods From October 2019 to October 2021, 119 consecutive patients with hepatocellular carcinoma (HCC) who underwent 134 sessions of TRA-TACE were included in this prospective single-center study. The compression time was measured by decompressing the device for 30 min, and thereafter, every 10 min after the procedure until complete hemostasis was achieved. Results Technical success was achieved for all TRA procedures. None of the patients experienced major TRA-related adverse events. Minor adverse events occurred in 7.5% of the patients. The mean compression time was 31.8 ± 5.0 min. Factors that may impact hemostasis were analyzed by univariate and multivariate analyses, and a platelet count < 100×109 /L (p = 0.016, odds ratio = 3.942) was found to be an independent factor that could predict the failure to achieve hemostasis within 30 min. For patients with a platelet count < 100×109 /L, the compression time required to achieve hemostasis was 60 min. For patients with a platelet count ≥ 100×109 /L, the compression time required to achieve hemostasis was 40 min. Conclusion To achieve hemostasis in patients with HCC treated with TRA-TACE, compression for 60 min is sufficient for those with a platelet count < 100×109 /L, and compression for 40 min is sufficient for those with a platelet count ≥ 100×109 /L.
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Affiliation(s)
- Yin-Gen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiao-Wu Zhang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiay-Wei Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ying Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jin-Gui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qing Peng
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ya-Wei Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Sun
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Correspondence: Xiao Li; He Zhao, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Tel/Fax +86 010 8778 8502, Email ;
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Study on the Safety of the New Radial Artery Hemostasis Device. J Interv Cardiol 2022; 2022:2345584. [PMID: 35463209 PMCID: PMC9005317 DOI: 10.1155/2022/2345584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Objective At present, the use of particular radial hemostatic devices after coronary angiography (CAG) or percutaneous coronary intervention (PCI) has become the primary method of hemostasis. Most control studies are based on the products already on the market, while only a few studies are on the new hemostatic devices. The aim of this study is to compare a new radial artery hemostasis device which is transformed based on the invention patent (Application number: CN201510275446) with TR Band (Terumo Medical) to evaluate its clinical effects. Methods In a prospective randomized clinical trial, 60 patients after CAG or PCI were randomly divided into two groups, patients in the trial group (CD group) using a new radial artery hemostasis device to stop bleeding and the control group (TR group) using the TR Band. The method is to collect relevant data of the two groups and compare the differences in hemostasis, local complications, and patient discomfort between the two groups. Results The hemostatic devices in both groups achieved adequate hemostasis, and there was no failure to stop bleeding. The new radial artery hemostasis device was better than the TR band in pain and swelling (P < 0.05). There were no significant differences in bleeding, hematoma, ecchymosis, skin damage, and local infection between the two groups (P > 0.05). Conclusions The sample of the new radial artery hemostasis device can stop bleeding effectively at the puncture site after CAG or PCI and is not inferior to the TR Band balloon hemostatic device in safety and is better in comfort.
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Kantak MN, Bharate SS. Analysis of clinical trials on biomaterial and therapeutic applications of chitosan: A review. Carbohydr Polym 2022; 278:118999. [PMID: 34973801 DOI: 10.1016/j.carbpol.2021.118999] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
Chitosan is a modified natural carbohydrate polymer derived from chitin that occurs in many natural sources. It has a diverse range of applications in medical and pharmaceutical sciences. Its primary and permitted use is biomaterial in medical devices. Chitosan and its derivatives also find utility in pharmaceuticals as an excipient, drug carrier, or therapeutic agent. The USFDA has approved chitosan usage as a biomaterial but not for pharmaceutical use, primarily because of the concerns over its source, purity, and immunogenicity. A large number of clinical studies are underway on chitosan-based materials/ products because of their diverse applications. Herein, we analyze clinical studies to understand their clinical usage portfolio. Our analysis shows that >100 clinical studies are underway to investigate the safety/efficacy of chitosan or its biomaterials/ nanoparticles, comprising ~95% interventional and ~ 5% observational studies. The regulatory considerations that limit the use of chitosan in pharmaceuticals are also deliberated. TEASER: Clinical Trials of Chitosan.
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Affiliation(s)
- Maithili N Kantak
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India
| | - Sonali S Bharate
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India.
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Narsinh KH, Mirza MH, Caton MT, Baker A, Winkler E, Higashida RT, Halbach VV, Amans MR, Cooke DL, Hetts SW, Abla AA, Dowd CF. Radial artery access for neuroendovascular procedures: safety review and complications. J Neurointerv Surg 2021; 13:1132-1138. [PMID: 34551991 DOI: 10.1136/neurintsurg-2021-017325] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/16/2021] [Indexed: 01/01/2023]
Abstract
Although enthusiasm for transradial access for neurointerventional procedures has grown, a unique set of considerations bear emphasis to preserve safety and minimize complications. In the first part of this review series, we reviewed anatomical considerations for safe and easy neuroendovascular procedures from a transradial approach. In this second part of the review series, we aim to (1) summarize evidence for safety of the transradial approach, and (2) explain complications and their management.
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Affiliation(s)
- Kazim H Narsinh
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Mohammed H Mirza
- Radiology, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - M Travis Caton
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Amanda Baker
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Ethan Winkler
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Randall T Higashida
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Van V Halbach
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Matthew R Amans
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Steven W Hetts
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Adib A Abla
- Neurological Surgery, University California San Francisco, San Francisco, California, USA
| | - Christopher F Dowd
- Radiology & Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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11
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Due-Tønnessen N, Egeland CH, Meyerdierks OJ, Opdahl A. Is radial artery occlusion and local vascular complications following transradial coronary procedures affected by the type of haemostasis device used? A non-inferiority Randomized Controlled Trial (RadCom trial). Eur J Cardiovasc Nurs 2021; 20:580-587. [PMID: 33615328 DOI: 10.1093/eurjcn/zvab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 11/17/2020] [Accepted: 01/15/2021] [Indexed: 12/21/2022]
Abstract
AIMS Vascular access site complications following transradial coronary procedures are less common and severe compared to femoral approach. Radial artery occlusion is considered the main adverse effect. As radial access is gaining more acknowledgement, complication awareness, and understanding is important. The aim was to assess complication rates following transradial coronary procedures and to compare two radial compression devices in a non-inferiority randomized controlled trial. METHODS AND RESULTS Four hundred and ninety-nine patients were randomized to radial compression with a new device (RY Stop, n = 248) or the reference device (TR Band, n = 251) following transradial coronary procedures. Radial artery occlusion persistent at 90 days was the primary endpoint. Discomfort and accounts of vascular complications at access site were secondary endpoints. Radial artery occlusion was observed in 5% (n = 26) for the entire cohort with no difference between groups (RY Stop 6% vs. TR Band 5%; P = 0.69). Patients overall reported low levels of discomfort and the median scores were similar in both groups; RY Stop: 7 vs. TR Band: 10 (P = 0.90). There were few incidents of bleeding (7%), however, they were significantly more frequent with the RY Stop (12%) than with the TR Band (3%; P = 0.001). Few patients (4%) developed access site haematomas, and the incidence was similar in the two groups (P = 0.98). CONCLUSION We observed a radial artery occlusion rate of 5% at 90 days post-procedure. Access site discomfort and vascular complication rates were low. Overall, the RY Stop compression device was not inferior to the TR Band except occurrences of bleeding.
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Affiliation(s)
- Nicole Due-Tønnessen
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Post Box 4950 Nydalen, 0424 Oslo, Norway
| | - Cecile H Egeland
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Post Box 4950 Nydalen, 0424 Oslo, Norway
| | - Oliver J Meyerdierks
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Post Box 4950 Nydalen, 0424 Oslo, Norway
| | - Anders Opdahl
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Post Box 4950 Nydalen, 0424 Oslo, Norway
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12
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Anchan R, Venturini J, Larsen P, Lee L, Fernandez C, Besser SA, Kalathiya R, Paul J, Blair J, Nathan S. Safe and rapid radial hemostasis achieved using a novel topical hemostatic patch: Results of a first-in-human pilot study using hydrophobically modified polysaccharide-chitosan. Catheter Cardiovasc Interv 2021; 99:786-794. [PMID: 33576564 DOI: 10.1002/ccd.29529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/17/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The transradial approach (TRA) for catheter interventions decreases vascular complications and bleeding versus transfemoral approach. Reducing time to hemostasis and preventing radial artery occlusion (RAO) following TRA are important and incompletely realized aspirations. OBJECTIVES This first-in-human study sought to evaluate the efficacy of a novel, topically applied compound (hydrophobically modified polysaccharide-chitosan, hm-P) plus minimal required pneumatic compression, to achieve rapid radial arterial hemostasis in post-TRA procedures compared with de facto standards. MATERIALS AND METHODS About 50 adult patients undergoing 6 French diagnostic TRA procedures were prospectively enrolled. At procedure completion, a topical hm-P impregnated patch was placed over the dermotomy and TR Band (TRB) compression was applied to the access site. This patch was used as part of a novel rapid deflation protocol with a primary outcome of time to hemostasis. Photographic and vascular ultrasound evaluation of the radial artery was performed to evaluate the procedural site. RESULTS Time to hemostasis was 40.5 min (IQR: 38-50 min) with the majority of patients (n = 39, 78%) not requiring reinflation. Patients with bleeding requiring TRB reinflation were more likely to have low body weight and liver dysfunction, with absence of hypertension and LV dysfunction. The rate of RAO was 0% with predischarge radial artery patency documented in all patients using vascular ultrasound. One superficial hematoma was noted. No late bleeding events or cutaneous reactions were reported in the study follow-up. CONCLUSIONS Topical application of hm-P in conjunction with pneumatic compression was safe and resulted in rapid and predictable hemostasis at the arterial puncture site.
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Affiliation(s)
- Rajeev Anchan
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Joseph Venturini
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Paul Larsen
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Linda Lee
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Christopher Fernandez
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Stephanie A Besser
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Rohan Kalathiya
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jonathan Paul
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - John Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Sandeep Nathan
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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13
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Singletary EM, Zideman DA, Bendall JC, Berry DA, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin A, Sakamoto T, Swain JM, Woodin JA, De Buck E, De Brier N, O D, Picard C, Goolsby C, Oliver E, Klaassen B, Poole K, Aves T, Lin S, Handley AJ, Jensen J, Allan KS, Lee CC. 2020 International Consensus on First Aid Science With Treatment Recommendations. Resuscitation 2020; 156:A240-A282. [PMID: 33098920 DOI: 10.1016/j.resuscitation.2020.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life- threatening bleeding through the use of tourniquets, haemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research. The 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) is the fourth in a series of annual summary publications from the International Liaison Committee on Resuscitation (ILCOR). This 2020 CoSTR for first aid includes new topics addressed by systematic reviews performed within the past 12 months. It also includes updates of the first aid treatment recommendations published from 2010 through 2019 that are based on additional evidence evaluations and updates. As a result, this 2020 CoSTR for first aid represents the most comprehensive update since 2010.
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14
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Singletary EM, Zideman DA, Bendall JC, Berry DC, Borra V, Carlson JN, Cassan P, Chang WT, Charlton NP, Djärv T, Douma MJ, Epstein JL, Hood NA, Markenson DS, Meyran D, Orkin AM, Sakamoto T, Swain JM, Woodin JA. 2020 International Consensus on First Aid Science With Treatment Recommendations. Circulation 2020; 142:S284-S334. [PMID: 33084394 DOI: 10.1161/cir.0000000000000897] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the summary publication of the International Liaison Committee on Resuscitation's 2020 International Consensus on First Aid Science With Treatment Recommendations. It addresses the most recent published evidence reviewed by the First Aid Task Force science experts. This summary addresses the topics of first aid methods of glucose administration for hypoglycemia; techniques for cooling of exertional hyperthermia and heatstroke; recognition of acute stroke; the use of supplementary oxygen in acute stroke; early or first aid use of aspirin for chest pain; control of life-threatening bleeding through the use of tourniquets, hemostatic dressings, direct pressure, or pressure devices; the use of a compression wrap for closed extremity joint injuries; and temporary storage of an avulsed tooth. Additional summaries of scoping reviews are presented for the use of a recovery position, recognition of a concussion, and 6 other first aid topics. The First Aid Task Force has assessed, discussed, and debated the certainty of evidence on the basis of Grading of Recommendations, Assessment, Development, and Evaluation criteria and present their consensus treatment recommendations with evidence-to-decision highlights and identified priority knowledge gaps for future research.
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15
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Roghani-Dehkordi F, Kasiri R, Kermani-Alghoraishi M, Akbari M. What is the preferred hemostasis method for coronary angiography through the palmar artery access? Cardiovasc Interv Ther 2020; 36:490-497. [PMID: 32910326 DOI: 10.1007/s12928-020-00707-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
Trans-palmar catheterization has been considered to be safe and feasible and choosing a reliable hemostasis method is essential to confirm it. The aim of our study was to compare the efficacy and safety of three hemostasis approaches containing ulnar TR band, manual compression and wrist hyperextension in patients undergoing trans-palmar coronary angiography (CAG). In a non-randomized clinical trial, a total of 106 patients undergoing diagnostic CAG by tarns-palmar access were divided into three groups: ulnar TR band, manual compression and wrist hyperextension. Duration of primary hemostasis, patient satisfaction, puncture site pain severity, hospitalization time and local neuro-vascular complication were evaluated and compared in hospital and 30 days follow-up. The mean age of the patients was 62.9 ± 7.4 years and 72 patients (67.9%) were male. Primary hemostasis time was significantly shorter in hyperextension (11.5 ± 2.10 min) and manual compression groups (12.3 ± 2.20 min) than with TR band group (24.7 ± 10.25 min) (p value < 0.0001). Patient's satisfaction was higher in hyperextension approach (9.4 ± 0.65) than manual compression (8.8 ± 0.79) and TR band group (8.2 ± 0.90) (p value < 0.0001). The most pain was seen in the TR band and the less in hyperextension group until 4 h after the procedure (p value < 0.0001). Hematoma, numbness and ulnar artery occlusion as well as hospitalization time did not have significant statistical differences (p value > 0.05). In conclusion, between three methods of hemostasis in trans-palmar catheterization, hyperextension approach is the preferred method because of effectiveness, safety and less time consuming hemostatic method compared others.
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Affiliation(s)
- Farshad Roghani-Dehkordi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 815-838-8994, Isfahan, Iran
| | - Roya Kasiri
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kermani-Alghoraishi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, PO Box 815-838-8994, Isfahan, Iran.
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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16
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Charlton NP, Swain JM, Brozek JL, Ludwikowska M, Singletary E, Zideman D, Epstein J, Darzi A, Bak A, Karam S, Les Z, Carlson JN, Lang E, Nieuwlaat R. Control of Severe, Life-Threatening External Bleeding in the Out-of-Hospital Setting: A Systematic Review. PREHOSP EMERG CARE 2020; 25:235-267. [DOI: 10.1080/10903127.2020.1743801] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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17
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A comparative study of Terumo radial Band® and PreludeSYNC hemostasis compression device after transradial coronary catheterization. Anatol J Cardiol 2020; 25:402-406. [PMID: 34100727 DOI: 10.14744/anatoljcardiol.2020.34694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Novel hemostasis strategies, including PreludeSYNC DISTAL, Merit Medical Systems, Inc. South Jordan, UT, USA (PSD) radial compression device for distal radial artery (DRA) access, have been described for radial access protocols. This study aimed to compare the safety profile of PSD and Terumo radial (TR) Band®. METHODS This prospective interventional study was conducted on patients who underwent coronary interventions via either the DRA or forearm radial artery (FRA). Patients with an arterial diameter of <2 mm, requiring dialysis, with unstable acute coronary syndrome, failed radial cannulation, and sheath insertion were excluded. PSD and TR Band® were used for hemostasis after DRA and FRA access, respectively. The time to hemostasis and complications, including minor/major hematoma, radial artery occlusion (RAO), and neurological symptoms (after 20 days) were recorded. The mean and standard deviation were calculated for age and hemostasis duration. Frequency and percentages were calculated for categorical variables. Independent t-test and Chi-squared test were performed to determine the significance of the differences between the two groups. A p-value of <0.05 was significant. RESULTS Of 139 participants, TR Band® and PSD were used in 76 and 63 patients, respectively. The mean age of the participants was 58.70±10.00 years, and the majority of the patients were men (67.60%). The hemostasis time of both devices was similar (p>0.490). Compared with PSD, TR Band® had more complications (52.63% vs. 23.81%; p=0.020), particularly RAO [odds ratio (OR), 3.17; p=0.018] and neurological problems (OR, 5.33; p=0.005). CONCLUSIONS Although, PSD seems safer in patients with coronary interventions, the device should further be explored in crossover trials for the two access types to determine the overall safety profile.
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18
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Chang KS, Kim BS, Shin J, Lim YH, Shin JH, Lee Y, Kim KS. Benefits of pressure-controlled hemostasis for transradial vascular access: a randomized controlled trial. Minerva Cardioangiol 2019; 68:34-41. [PMID: 31789006 DOI: 10.23736/s0026-4725.19.05022-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transradial vascular access is widely used due to advantages such as facile hemostasis and reduced bed rest time. Accordingly, several hemostatic devices have been introduced for transradial vascular access. However, the pain caused by hemostatic compression has not yet been resolved. The objective of this study was to determine the optimal compression pressure to minimize pain at the hemostasis site without increasing complications after transradial catheterization. METHODS A total of 86 patients who underwent transradial catheterization from November 2014 to March 2015 were prospectively enrolled in this study. In group I (N.=42), the radial arteries were compressed by adjusting the air volume to reach systolic blood pressure plus 20 mmHg. For group II (N.=44), "conventional hemostasis" was performed by injecting a fixed volume (15 mL) of air into the air bag of the TR band. Complications, including pain, rebleeding, hematoma, and radial artery occlusion, were compared between the two groups. In addition, the pain level at the hemostasis site was assessed using a visual analog scale. RESULTS The visual analog scale of group I was significantly lower than that of group II (1.548±1.549 vs. 2.466±1.682, P=0.01 at application; 1.202±1.700 vs. 2.818±2.060, P<0.001 at removal). The other complications were not significantly different between the two groups. CONCLUSIONS Compared to conventional hemostasis, pressure-controlled hemostasis with systolic blood pressure plus 20 mmHg significantly reduced pain at the hemostasis site after transradial vascular access without increasing the incidence of other complications.
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Affiliation(s)
- Ki-Sul Chang
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Byung-Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Yonggu Lee
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea
| | - Kyung-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea -
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19
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Roberts JS, Niu J, Pastor-Cervantes JA. Comparison of Hemostasis Times with a Chitosan-Based Hemostatic Pad (Clo-SurPlus Radial™) vs Mechanical Compression (TR Band®) Following Transradial Access: A pilot Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:871-874. [DOI: 10.1016/j.carrev.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 01/04/2023]
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20
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Córdova ESM, Santos LRD, Toebe D, Moraes MAPD, Souza END. Incidence of hemorrhagic complications with use of a radial compression device: a cohort study. Rev Esc Enferm USP 2018; 52:e03410. [PMID: 30540128 DOI: 10.1590/s1980-220x2017041003410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/24/2018] [Indexed: 08/30/2023] Open
Abstract
OBJECTIVE To examine the incidence of hemorrhagic complications in patients undergoing radial cardiac catheterization and using a hemostatic device for arterial compression. METHOD A prospective cohort study conducted with patients undergoing elective cardiac catheterization in two hemodynamic laboratories in southern Brazil. The TR Band® radial compression device was used during 4 hours for hemostasis of the arterial puncture site. Hematomas and minor bleeding were the outcomes evaluated. RESULTS A total of 244 patients were evaluated. The mean age was 63.5±10.9 years, 61.9% were male, 73.8% had systemic arterial hypertension (SAH) and 42.8% were dyslipidemic. Type I hematoma occurred in 1.2% of patients and minor bleeding in 9% after removal of the device. There was no significant association between hematomas and bleeding, and patients who used oral anticoagulants (p=0.604) and prior use of antiplatelets (p=0.958). CONCLUSION The use of the hemostatic device for radial artery compression was safe in clinical practice and there was a low incidence of hematomas and minor bleeding after radial coronary angiography.
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Affiliation(s)
| | | | - Daiane Toebe
- Fundação Universitária de Cardiologia do Rio Grande de Sul, Instituto de Cardiologia, Programa de Residência Multiprofissional em Saúde, Porto Alegre, RS, Brazil
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21
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Campos MADC, Alves CMR, Tsunemi MH, Peterlini MAS, Avelar AFM. Randomized clinical study on radial artery compression time after elective coronary angiography. Rev Lat Am Enfermagem 2018; 26:e3084. [PMID: 30517575 PMCID: PMC6280184 DOI: 10.1590/1518-8345.2584.3084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022] Open
Abstract
Objective to compare two compression times of the radial artery after coronary
angiography with customized compressive dressing regarding the occurrence of
hemostasis and vascular complications. Method a randomized clinical study was carried out in patients undergoing elective
transradial coronary angiography in two study groups: (G30), whose
compressive dressing was maintained for 30 minutes, and (G60), whose
compressive dressing was maintained for 60 minutes, both until the first
evaluation of hemostasis. Variables related to patients, procedure,
occurrence of hemostasis, and vascular complications were analyzed. Patency
of the radial artery was assessed with Doppler vascular ultrasonography,
immediately after removing the compressive dressing and 30 days after the
procedure. Results the sample consisted of 152 patients in G30 and 151 in G60. Hemostasis was
evidenced in the first evaluation in 76.3% of G30 patients and 84.2% of G60
patients (p = 0.063). There were 91 immediate complications, being 53
hematomas and 38 occlusions of the radial artery. We identified 18 late
occlusions, 7 (5.5%) in G30 and 11 (8.2%) in G60. Conclusion the different compression times of the radial artery after coronary
angiography did not significantly influence the occurrence of hemostasis and
vascular complications. Brazilian Registry of Clinical Trials (Rebec): RBR-7VJYMJ.
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Affiliation(s)
| | | | - Miriam Harumi Tsunemi
- Universidade Estadual Paulista Júlio de Mesquita Filho, Instituto de Biociências, Botucatu, SP, Brasil
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22
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Van Meter C, Vasudevan A, Cuccerre JM, Schussler JM. Time to discharge following diagnostic coronary procedures via transradial artery approach: A comparison of Terumo band and StatSeal hemostasis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:759-761. [PMID: 29628222 DOI: 10.1016/j.carrev.2018.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/27/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The transradial artery (TRA) approach for cardiac catheterization is associated with fewer complications, earlier mobilization and a shorter stay at the hospital. The objective of this study was to determine whether hemostasis with a combination of a compression band (Terumo TR band™) and a hemostatic patch (StatSeal™) decreases the time to discharge from the hospital compared to the Terumo (TR) band alone in patients undergoing diagnostic coronary catheterizations through a TRA approach. METHODS We retrospectively looked at 445 patients who underwent diagnostic coronary angiography through the TRA approach at the Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas between July 2016 and June 2017. The difference in the time to discharge between the two groups was assessed by a Wilcoxon Rank-sum test. RESULTS The combination of a TR band and a StatSeal hemostatic patch was used in 70.3% (313) of the patients. Comparison of the two groups demonstrated a statistically significant reduction in time from the end of the procedure to discharge (p < 0.001), with no significant alteration in safety among those with a combination of TR band and a StatSeal hemostatic patch. CONCLUSION With increasing frequency of TRA procedures in the United States, we demonstrate one effective method to significantly reduce the time to radial hemostasis and reduce the time to patient discharge from the hospital.
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Affiliation(s)
- Ceton Van Meter
- Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Baylor Heart and Vascular Institute, Dallas, TX, United States.
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Dallas, TX, United States; Baylor Scott & White Research Institute, Dallas, TX, United States; Texas A&M, College of Medicine, Dallas, TX campus, United States.
| | | | - Jeffrey M Schussler
- Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, United States; Baylor Heart and Vascular Institute, Dallas, TX, United States; Baylor University Medical Center, Department of Internal Medicine, Dallas, TX, United States; Texas A&M, College of Medicine, Dallas, TX campus, United States. https://twitter.com/Updock
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Voon V, AyyazUlHaq M, Cahill C, Mannix K, Ahern C, Hennessy T, SamerArnous, Kiernan T. Randomized study comparing incidence of radial artery occlusion post-percutaneous coronary intervention between two conventional compression devices using a novel air-inflation technique. World J Cardiol 2017; 9:807-812. [PMID: 29225736 PMCID: PMC5714808 DOI: 10.4330/wjc.v9.i11.807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare post-percutaneous coronary intervention (PCI) radial artery occlusion (RAO) incidence between two conventional radial artery compression devices using a novel air-inflation technique.
METHODS One hundred consecutive patients post-PCI were randomized 1:1 to Safeguard or TR band compression devices. Post-radial sheath removal, each compression device was inflated with additional 2 mL of air above index bleeding point during air-filled device application and gradually down-titrated accordingly. RAO was defined as absence of Doppler flow signal performed at 24 h and at 6 wk post-PCI. Patients with missing data were excluded. Statistical significance was defined as P < 0.05.
RESULTS All patients had 6F radial sheath inserted. No significant differences were observed between Safeguard Radial (n = 42) vs TR band (n = 42) in terms of age (63 ± 11 years vs 67 ± 11 years), clinical presentation (electives, n = 18 vs n = 16; acute coronary syndrome, n = 24 vs n = 26) and total procedural heparin (7778 ± 2704 IU vs 7825 ± 2450 IU). RAO incidence was not significantly different between groups at 24 h (2% vs 0%, P = 0.32) and 6 wk (0%, both).
CONCLUSION Safeguard Radial and TR band did not demonstrate significant between-group differences in short-term RAO incidence. Lack of evidence of RAO in all post-PCI patients at 6 wk follow-up, regardless of radial compression device indicate advantage of using the novel and pragmatic air-inflation technique. Further work is required to more accurately confirm these findings.
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Affiliation(s)
- Victor Voon
- Terry Hennessy, SamerArnous, Thomas Kiern, Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Muhammad AyyazUlHaq
- Terry Hennessy, SamerArnous, Thomas Kiern, Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Ciara Cahill
- Terry Hennessy, SamerArnous, Thomas Kiern, Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Kirsten Mannix
- Terry Hennessy, SamerArnous, Thomas Kiern, Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Catriona Ahern
- Terry Hennessy, SamerArnous, Thomas Kiern, Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Kang SH, Han D, Kim S, Yoon CH, Park JJ, Suh JW, Cho YS, Youn TJ, Chae IH. Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial. PLoS One 2017; 12:e0181099. [PMID: 28742134 PMCID: PMC5524363 DOI: 10.1371/journal.pone.0181099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Arterial access and hemostasis are important processes during percutaneous coronary procedures. In this study, we tested if the use of chitosan-based pads on top of compression devices could improve hemostasis efficacy compared with compression devices alone after transradial coronary angiography or interventions. METHODS This study was a single-center open-label randomized controlled trial. Patients who underwent coronary angiography or intervention with the transradial approach were randomly assigned to the study (compression device and a chitosan-based pad) or control (compression devices alone) group in a 2:1 fashion. The primary endpoint was time to hemostasis, categorized into ≤5, 6-10, 11-20, and >20 minutes. RESULTS Between April and July 2016, 95 patients were enrolled (59 were assigned to the study arm and 36 to the control arm). Time to hemostasis, the primary endpoint, was significantly lower in the study group than in the control group (p<0.001). Both groups showed low rates of vascular complications. CONCLUSIONS This study suggests that the use of a hemostasis pad in combination with rotatory compression devices is a safe and effective hemostasis strategy after radial artery access. TRIAL REGISTRATION ClinicalTrials.gov NCT02954029.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Donghoon Han
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sehun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jin-Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- * E-mail:
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The hemostatic efficacy of chitosan-pads in hemodialysis patients with significant bleeding tendency. J Vasc Access 2017; 18:220-224. [PMID: 28478622 DOI: 10.5301/jva.5000707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients on chronic hemodialysis often have acquired coagulopathy that can aggravate bleeding from puncture site after needle extraction. Chitosan-based pads have been reported to accelerate hemostasis even in the presence of coagulopathy. The aim of this study was to evaluate the hemostatic efficacy of the chitosan pads compared to gauze pads, applied for local hemostasis. METHODS A crossover study in a cohort of patients on hemodialysis with extended time to hemostasis after needle extraction. At the end of each dialysis, either gauze or chitosan pad was applied on both access points (arterial and venous). The type of pad was changed in the next dialysis all together 5 times in each patient (10 applications per patient for every pad). RESULTS A total of 288 applications, 144 for each type of pad, were performed in 15 patients. The average time to hemostasis for the entire group was significantly shorter with the chitosan pads compared to the regular gauze pads ("arterial" point 3 vs. 18.5 min, p<0.001 "venous" access 2.8 vs. 13.2 min, p<0.001, respectively). CONCLUSIONS Chitosan pads significantly reduce time to hemostasis and should be considered for the treatment of accessible bleeds in patients with coagulopathy.
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Fernandez RS, Lee A. Effects of methods used to achieve hemostasis on radial artery occlusion following percutaneous coronary procedures: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:738-764. [PMID: 28267032 DOI: 10.11124/jbisrir-2016-002964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Transradial access to percutaneous coronary procedures is becoming the preferred access route, and it is being increasingly used for emergent and elective procedures. However, radial artery occlusion (RAO) continues to remain an adverse occurrence following sheath removal or in the first 24 hours following sheath removal due to the smaller diameter of the artery. OBJECTIVES The overall objective of this study was to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on RAO rates after percutaneous coronary procedures. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered trials that included adult patients (18 years and over) who have had a coronary angiography or coronary re-vascularization intervention via the radial artery. TYPES OF INTERVENTION(S) The interventions of interest were the use of various hemostatic methods compared to traditional interventions to prevent RAO. TYPES OF STUDIES All randomized and quasi-randomized controlled trials evaluating the effect of various hemostatic methods on RAO rates after percutaneous coronary procedures were included in the review. OUTCOMES The primary outcome of interest was the incidence of RAO at the time of discharge and persistent occlusion at the time of follow-up. SEARCH STRATEGY The search aimed to find published and unpublished trials through electronic databases, reference lists and key reports. An extensive search was undertaken for the following databases - CINAHL, Embase, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Databases were searched up to May 2016. The search for unpublished trials included Dissertation Abstracts International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and Theses and MedNar. METHODOLOGICAL QUALITY Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Disagreements that arose between the reviewers were resolved through discussion. DATA EXTRACTION Quantitative data were extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-MAStARI. The data extracted were checked by a second reviewer. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry in Review Manager. DATA SYNTHESIS Statistical pooling of the data was not possible due to the heterogeneity of the trials; therefore, the findings are presented in narrative form. However, figures have been used to illustrate the results. RESULTS A total of seven trials were included in the review. One trial demonstrated a significant reduction in RAO rates in patients who had a mean arterial pressure (MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95% confidence interval [CI] 0.02, 0.37). A statistically significant reduction in the incidence of RAO was observed among patients who received a biopolymer dressing (Chitosen) compared to those who received the TR band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference in the incidence of RAO was reported between those who received the TR band and those who received either the elastic bandage (P = 0.08) or T band (P = 0.76). Similarly, no statistically significant difference in rates of RAO among patients was reported among those who had pro-coagulant dressings compared to those who had short or long manual compression. One trial that compared the TR band to a MAP-guided TR band demonstrated no statistically significant difference in the time taken to obtain hemostasis between the two groups (P = 0.61). A statistically significant reduction in the time taken to obtain hemostasis was observed among patients who received the hemostatic biopolymer dressing compared to the TR band. No statistically significant difference in the incidence of hematoma was identified among patients who received pneumatic compression or traditional compression to achieve hemostasis. CONCLUSION There is limited evidence to support the use of any single hemostatic method to prevent RAO rates after percutaneous coronary procedures. Although used extensively, there is evidence of no effect of the pneumatic compression method using the TR band on the incidence of RAO at discharge or follow-up, the time taken to obtain hemostasis and the incidence of hematoma. The MAP-guided compression method and the Biopolymer dressing (Chitosen) were superior to the TR band compression method, and patent hemostasis was superior to hemoband in the prevention of RAO. However, these results are based on single trials and should be interpreted with caution. The evidence obtained from the review does not provide a concrete base for the development of practice guidelines. Until more robust evidence is available, practices will continue to be dictated by local preferences and available resources.
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Affiliation(s)
- Ritin S Fernandez
- 1Centre for Evidence Based Initiatives in Health Care: a Joanna Briggs Institute Centre of Excellence 2School of Nursing, University of Wollongong, Wollongong, Australia 3Centre for Research in Nursing and Health, St George Hospital, Sydney, Australia 4Wollongong Hospital, Wollongong, Australia 5School of Medicine, University of Wollongong, Wollongong, Australia
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Deuling JH, Vermeulen RP, van den Heuvel ADFM, Schurer RAJ, van der Harst P. A randomised controlled study of standard versus accelerated deflation of the Terumo radial band haemostasis device after transradial diagnostic cardiac catheterisation. Eur J Cardiovasc Nurs 2016; 16:344-351. [DOI: 10.1177/1474515116672123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- J Han Deuling
- Department of Cardiology, University Medical Centre Groningen, The Netherlands
| | - Robert P Vermeulen
- Department of Cardiology, University Medical Centre Groningen, The Netherlands
| | | | - Remco AJ Schurer
- Department of Cardiology, University Medical Centre Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Centre Groningen, The Netherlands
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