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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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Badescu MC, Ciocoiu M, Rezus E, Badulescu OV, Tanase DM, Ouatu A, Dima N, Ganceanu-Rusu AR, Popescu D, Seritean Isac PN, Genes TM, Rezus C. Current Therapeutic Approach to Acute Myocardial Infarction in Patients with Congenital Hemophilia. Life (Basel) 2021; 11:1072. [PMID: 34685443 PMCID: PMC8537181 DOI: 10.3390/life11101072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 12/22/2022] Open
Abstract
Advances in the treatment of hemophilia have made the life expectancy of hemophiliacs similar to that of the general population. Physicians have begun to face age-related diseases not previously encountered in individuals with hemophilia. Treatment of acute myocardial infarction (AMI) is particularly challenging because the therapeutic strategies influence both the patient's thrombotic and hemorrhagic risk. As progress has been made in the treatment of AMI over the last decade, we performed an in-depth analysis of the available literature, highlighting the latest advances in the therapy of AMI in hemophiliacs. It is generally accepted that after the optimal substitution therapy has been provided, patients with hemophilia should be treated in the same way as those in the general population. New-generation stents that allow short dual antiplatelet therapy and potent P2Y12 receptor inhibitors have begun to be successfully used. At a time when specific recommendations and relevant data are scarce, our study provides up-to-date information to physicians involved in the treatment of AMI in hemophiliacs.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Anca Ouatu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ana Roxana Ganceanu-Rusu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
| | - Tudor-Marcel Genes
- Department of Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Neurological Rehabilitation Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.M.T.); (A.O.); (N.D.); (A.R.G.-R.); (D.P.); (P.N.S.I.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Petroglou D, Didagelos M, Alkagiet S, Koutouzis M, Karvounis H, Bertrand OF, Ziakas A. Manual Radial Artery Compression After Transradial Coronary Procedures: Is It Safe to Go Bare-Handed? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:912-916. [PMID: 31864953 DOI: 10.1016/j.carrev.2019.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/15/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
Although the superiority of manual compression of the radial, mainly due to its selectivity and progressive grading, had been hypothesized from the early days of the transradial use, data on efficacy and safety of this method are only scarce. This review tries to delineate the aspects of manual hemostasis in transradial catheterization. Current data demonstrate that manual compression of the radial artery is a possible (second line) hemostatic option in transradial catheterization with main advantage the shorter hemostasis duration, and major disadvantage the need for larger involvement of post-procedural care team in hemostasis. Manual compression of the radial artery is a possible (second line) hemostatic option with main advantage the shorter hemostasis duration, and major disadvantages the need for larger involvement of post-procedural care team in hemostasis.
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Affiliation(s)
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece.
| | - Stelina Alkagiet
- Cardiology Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Michael Koutouzis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - Olivier F Bertrand
- Quebec Heart-Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
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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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Petroglou D, Didagelos M, Chalikias G, Tziakas D, Tsigkas G, Hahalis G, Koutouzis M, Ntatsios A, Tsiafoutis I, Hamilos M, Kouparanis A, Konstantinidis N, Sofidis G, Pancholy SB, Karvounis H, Bertrand OF, Ziakas A. Manual Versus Mechanical Compression of the Radial Artery After Transradial Coronary Angiography: The MEMORY Multicenter Randomized Trial. JACC Cardiovasc Interv 2019; 11:1050-1058. [PMID: 29880098 DOI: 10.1016/j.jcin.2018.03.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES The aim of this study was to compare manual versus mechanical compression of the radial artery after coronary angiography via transradial access regarding radial artery occlusion (RAO), access-site bleeding complications, and duration of hemostasis. BACKGROUND Hemostasis of the radial artery after sheath removal can be achieved either by manual compression at the puncture site or by using a mechanical hemostasis device. Because mechanical compression exerts a more stable, continuous pressure on the artery, it could be hypothesized that it is more effective compared with manual compression regarding hemostasis time, bleeding, and RAO risks. METHODS A total of 589 patients undergoing diagnostic coronary angiography by transradial access with a 5-F sheath were randomized in a 1:1 ratio to receive either manual or mechanical patent hemostasis of the radial artery. Radial artery patency was evaluated by color duplex ultrasonography 24 h after the procedure. The primary endpoint was early RAO at 24 h. Secondary endpoints included access-site bleeding complications and duration of hemostasis. RESULTS Thirty-six (12%) early RAOs occurred in the manual group, and 24 (8%) occurred in the mechanical group (p = 0.176). There were no significant differences between the 2 groups regarding access-site bleeding complications (hematoma, 52 [17%] vs. 50 [18%]; p = 0.749; bleedings, 8 [3%] vs. 9 [3%]; p = 1.000). Duration of hemostasis was significantly shorter in the manual group (22 ± 34 min vs. 119 ± 72 min with mechanical compression; p < 0.001). CONCLUSIONS Manual and mechanical compression resulted in similar rates of early RAO, although the total duration of hemostasis was significantly shorter in the manual group.
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Affiliation(s)
- Dimitrios Petroglou
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Grigorios Tsigkas
- Cardiology Department, School of Medicine, University of Patras, Rion, Greece
| | - Georgios Hahalis
- Cardiology Department, School of Medicine, University of Patras, Rion, Greece
| | - Michael Koutouzis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Antonios Ntatsios
- Department of Cardiology, General Hospital of Veroia, Veroia, Greece
| | - Ioannis Tsiafoutis
- Cardiology Department, Hellenic Red Cross General Hospital, Athens, Greece
| | - Michael Hamilos
- Cardiology Department, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Antonios Kouparanis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Konstantinidis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Sofidis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Samir B Pancholy
- The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, Pennsylvania
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Antonios Ziakas
- 1st Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Susanu S, Angelillis M, Giannini C, Binella R, Matteoni A, Bellucci R, Balestri S, Ferrara N, Falchi F, Micheletti G, Petronio AS. Radial access for percutaneous coronary procedure: relationship between operator expertise and complications. Clin Exp Emerg Med 2018; 5:95-99. [PMID: 29973034 PMCID: PMC6039363 DOI: 10.15441/ceem.17.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/13/2017] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to investigate (1) whether the learning curve of new catheterization laboratory operators increases the incidence of complications of transradial access during percutaneous coronary interventions and (2) whether manual compression with a two-step approach is safe and efficient for radial access hemostasis. Methods We performed a prospective study with all consecutive patients who underwent a coronary diagnostic or intervention procedure with radial access. The primary end point was a composite of pulseless radial artery of the wrist and hematoma evaluated after 24 hours. The secondary end point of efficacy was defined as the presence of bleeding or hematoma after 30 seconds. Results From March 2016 to June 2016, 150 consecutive patients, of whom 147 underwent coronary angiography and/or percutaneous coronary intervention through radial access, were included in the present study. The primary end point was present in 33%, but pulseless radial artery of the wrist was present only in 5.3%. We found that the incidence of primary end point was statistically different according to the number of puncture attempts, with a cutoff of two punctures with blood. The secondary end point of safety was present only in 4.7% of the cases. Conclusion Radial access is feasible and safe even if performed by training physicians. Manual compression with early evaluation after 30 seconds is a safe technique for managing the radial access after sheath removal.
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Affiliation(s)
- Simona Susanu
- Catheterization Laboratory, University of Pisa, Pisa, Italy
| | | | | | | | - Anna Matteoni
- Catheterization Laboratory, University of Pisa, Pisa, Italy
| | - Rita Bellucci
- Catheterization Laboratory, University of Pisa, Pisa, Italy
| | | | - Nicola Ferrara
- Catheterization Laboratory, University of Pisa, Pisa, Italy
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