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Takamatsu S, Kagiyama N, Sone N, Tougi K, Yamauchi S, Yuri T, Ii N, Sugimoto T, Masutani M, Hirohata A. Impact of radial compression protocols on radial artery occlusion and hemostasis time in coronary angiography. Cardiovasc Interv Ther 2023; 38:202-209. [PMID: 36478329 PMCID: PMC10020254 DOI: 10.1007/s12928-022-00896-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
Protocols for hemostasis after trans-radial approach (TRA) vary depending on the institute as there is no established evidence-based protocol. This study aimed to investigate the clinical implications of radial compression protocols. Consecutive patients who underwent outpatient invasive catheter angiography before and after April 2018 were treated with traditional and new protocols, respectively. Using the same hemostasis band, in the conventional protocol, fixed amount of air was removed soon after the procedure, 2 h later, and 3 h later, whereas the air was removed as much as possible every 30 min in the new protocol. A total of 1842 patients (71 ± 10 years old, 77% male) were included. Compared with the traditional protocol group (n = 1001), the new protocol group (n = 841) had a significantly lower rate of dual antiplatelet therapy (35% and 24% in the traditional and new groups, respectively, p < 0.001). The time required for complete hemostasis was approximately one-third with the new protocol (190 ± 16 and 66 ± 32 min, p < 0.001) with no clinically relevant bleeding. The incidence of radial artery occlusion (RAO) was 9.8% and 0.9% in the traditional and new protocol groups, respectively (p < 0.001). After adjusting for covariates, the new protocol was associated with a reduced risk of RAO (odds ratio 0.10, p < 0.001) and a shorter hemostasis time (odds ratio 0.01, p < 0.001). The new protocol for hemostasis after TRA was strongly associated with a shorter hemostasis time and a lower rate of RAO.
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Affiliation(s)
- Sachiko Takamatsu
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuyuki Kagiyama
- Department of Digital Health and Telemedicine R&D, Juntendo University, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
- Department of Cardiovascular Biology and Medicine, Juntendo University, Tokyo, Japan.
| | - Naohiko Sone
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kiyotaka Tougi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Shuichiro Yamauchi
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Takuya Yuri
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Nobuhisa Ii
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Tomoko Sugimoto
- Department of Nursing, Hakuhoukai Central Hospital, Hyogo, Japan
| | | | - Atsushi Hirohata
- Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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Takamatsu S, Kagiyama N, Shiomi T, Mizobuchi M, Sone N, Tougi K, Yamauchi S, Yuri T, Fukuyama S, Shibata M, Nakazawa R, Ii N, Masutani M, Hirohata A. Impact of radial compression protocols on the compression time and radial artery occlusion. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Trans-radial access (TRA) has been established as a safe and established approach for invasive coronary catheter procedures. However, protocols for post-procedural hemostasis varies depending on institutes and an evidence-based protocol is lacking.
Purpose
The objective of this study was to investigate the clinical implications of procedural hemostasis.
Methods
Consecutive patients who were referred to outpatient catheter examination before and after April 2018 were treated with an old and a new protocol, respectively. In both protocols, we used the same commercially available hemostasis band with injecting an air of 16 ml for hemostasis. In the old protocol, the amount and timing of deflation were fixed, whereas the air was removed as much as possible for every 30 minutes in the new protocol. Time to complete hemostasis, the rate of major bleeding, and the rate of radial artery occlusion (RAO) at 6 months after the catheter examination were compared between the protocols.
Results
Total of 1,843 (71±10 years old, 77% male) patients was included in the study. Between patients in the old and the new protocol group (n=1,000 and 843, respectively), there was no significant difference in age, gender, body size, or systolic blood pressure. The new group had significantly higher prevalence of diabetes (47% vs 39%, p=0.002), slightly larger sheath size (4.1±0.3 vs 4.0±0.2 Fr, p<0.001), and lower rate of dual antiplatelet therapy (DAPT: 24% vs. 35%, p<0.001). Time for complete hemostasis was about one-third with the new protocol compared with the old protocol (65±32 vs. 190±16 min, p<0.001) and there was no major bleeding in either group. The rate of radial artery occlusion was 0.7% and 9.8% in the old and the new group (p<0.001). Multivariate analysis showed that the significant predictor of prolonged hemostasis time were the old protocol (odds ratio: OR 80.5, p<0.001) and the prescription of DAPT (OR 2.9, p<0.001), while the factors associated with higher risk of radial occlusion were the old protocol (OR 13.9, p<0.001), the number of previous TRA (OR 1.1, p<0.001), and smaller body size (OR 0.127 per 1 m2 increase p=0.005).
Conclusions
Our new protocol for hemostasis after TRA was strongly associated with shorter hemostasis time and a lower rate of radial artery occlusion. This approach will decrease the post-procedural hospital time with even fewer complication rates.
Study outline
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Takamatsu
- The Sakakibara Heart Institute of Okayama, Department of Nursing, Okayama, Japan
| | - N Kagiyama
- West Virginia University Hospital, Morgantown, United States of America
| | - T Shiomi
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - M Mizobuchi
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - N Sone
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - K Tougi
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - S Yamauchi
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - T Yuri
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - S Fukuyama
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - M Shibata
- The Sakakibara Heart Institute of Okayama, Department of Nursing, Okayama, Japan
| | - R Nakazawa
- The Sakakibara Heart Institute of Okayama, Department of Nursing, Okayama, Japan
| | - N Ii
- The Sakakibara Heart Institute of Okayama, Department of Nursing, Okayama, Japan
| | - M Masutani
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
| | - A Hirohata
- The Sakakibara Heart Institute of Okayama, Cardiovascular Medicine, Okayama, Japan
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