Comparison of low dose versus standard dose heparin for radial approach in elective coronary angiography?

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Abstract

Objective

The aim of this study is to evaluate the efficacy and safety of two doses of heparin, a low dose (2500 IU) and a standard dose (5000 IU) in patients who underwent transradial coronary angiography (TRCAG).

Methods

A total of 459 consecutive patients were included in the present study, 217 in the 2500-IU heparin group and 242 in the 5000-IU heparin group. Radial artery patency was evaluated one month after the TRCAG with Doppler ultrasonography.

Results

The RAO was observed in 15 (3.3%) patients. The RAO was significantly higher in 2500 IU heparin group than 5000 IU heparin group (5.5% vs 1.2% p = 0.010, respectively). Female gender (Odds ratio (OR) = 66.135, p = 0.002, 95% confidence interval (CI) = 4.584–954.131), sheath removal time (OR = 1.496, p < 0.001, 95% CI = 1.254–1.784) and administration of 2500 IU heparin (OR = 9.758, p = 0.034, 95% CI = 1.195–79.695) were the independent predictors of RAO in multivariate regression analysis. While the presence of hypertension was independently associated with radial artery patency in multivariate regression analysis (OR = 0.022, p = 0.005, 95% CI = 0.002–0.307).

Conclusion

The patients in the standard dose heparin group had lower RAO rates compared to low dose group in this study. This suggests that using the current technique, standard dose of heparin is still required for transradial diagnostic angiography.

Introduction

Radial artery occlusion (RAO) is usually silent but an undesired complication of transradial coronary angiography (TRCAG). The reported incidence of RAO is varying [1]. The incidence of RAO is affected by many factors including patient weight, the ratio between the radial artery diameter and sheath size, repeated procedures, prolonged cannulation time, compression method, and heparin dose (1). Greater incidence of RAO was reported with the combination of low doses of heparin and occlusive radial artery compression [2], [3]. However, the usage of patent hemostasis method reduces the incidence of RAO [4]. Various studies reported an association between heparin dosage and RAO. However the optimal dose of heparin administration was still debatable. In the present study, we evaluated the incidence of RAO with 2 doses of heparin, a low dose (2500 IU) and a standard dose (5000 IU) in patients who underwent TRCAG.

Section snippets

Methods

This prospective study was conducted at our clinic between March 2013 and November 2013. We enrolled 744 consecutive patients and randomized in a 1:1 ratio before cardiac diagnostic catheterization from the right radial artery to a low (2500 IU) or standard (5000 IU) dose of unfractionated heparin. All patients had a good pulsating radial artery and normal oximetry–plethysmography testing before TRCAG. Patients taking warfarin, with acute coronary syndrome, admitted for elective percutaneous

Results

A total of 459 (355 male) patients were included in the present study, 217 (160 male) in the 2500-IU group and 242 (195 male) in the 5000-IU group. The characteristics of patients are shown in Table 1. The mean age of the patients was similar in both groups. Prevalence of hypertension, diabetes mellitus, dyslipidemia and smoking in both groups were similar. The procedure time, fluoroscopy time and sheath removal time were similar in both groups. While the fasting glucose, HDL, triglyceride,

Discussion

In the present study we have shown that female sex, sheath removal time and heparin dosage were the independent predictors of RAO. While the presence of hypertension was associated with radial artery patency.

Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL) and radial versus femoral randomized investigation in ST-elevation acute coronary syndrome (RIFLE-STEACS) studies have shown significant clinical benefits in terms of

Conclusion

The patients in the standard dose heparin group had lower RAO rates compared to low dose group in this study. This suggests that using the current technique, standard dose of heparin is still required for transradial diagnostic angiography.

Acknowledgments

None declared.

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