Role of trans-radial band protocols in radial artery occlusion: Randomized trial

Enhancing heart and circulatory well-being through optimized radial artery techniques: a meta-analysis of hemostasis and patient comfort

Objective

This meta-analysis elucidates the efficacy of the Transradial Band Device (TR Band) in minimizing complications like radial artery occlusion and hematoma, preserving heart health, and enhancing blood flow post-transradial catheterization.

Methods

A comprehensive literature search across databases including PubMed, Cochrane, and Embase examined the impact of radial artery compression techniques and decompression times on complications. Data from 13 studies were analyzed using R 4.1.2 with fixed-effects and random-effects models. The Newcastle-Ottawa Scale assessed the risk of bias in observational cohort studies.

Results

In our meta-analysis, we evaluated data from various studies encompassing different air volumes in transradial band devices across several outcomes including bleeding, hematoma, radial artery occlusion (RAO), Visual Analog Scale (VAS) scores, and compression time. The collective analysis integrated findings from 11 studies, totaling 4,679 patients. No significant difference in bleeding risk (OR 1.04, 95% CI 0.60-1.82, p > 0.05, I 2 = 78%), hematoma incidence (OR 0.96, 95% CI 0.78-1.19, p > 0.05, I 2 = 0%), or RAO incidence (OR 0.96, 95% CI 0.78-1.19, p > 0.05, I 2 = 0%) was observed between the "Less air" and "15 ml air" groups. However, the "Less air" group reported significantly higher VAS scores indicating increased pain or discomfort (Mean Difference 0.25, 95% CI 0.09-0.41, p < 0.05, I 2 = 0%). Compression time analyses showed no significant difference between groups (Mean Difference -17.73, 95% CI -54.65-19.20, p > 0.05, I 2 = 99%). Sensitivity analyses confirmed the stability of these findings, and Egger's test indicated no significant publication bias across the outcomes. This synthesis highlights the nuanced impact of air volume adjustments in transradial bands on patient outcomes, emphasizing the necessity for further research and standardized protocols to optimize patient safety and comfort post-intervention.

Conclusion

The TR Band, when utilized with optimized air volume/pressure, maintains an essential balance between ensuring hemostasis and enhancing patient comfort without elevating the risk of radial artery complications. These findings support the careful selection of TR Band settings to optimize clinical outcomes in patients undergoing transradial cardiac procedures. Further research is warranted to establish standardized guidelines for the most effective use of TR Band in various clinical scenarios.

Platelet reactivity and activated clotting time predict hemorrhagic site complications in patients with chronic coronary syndromes undergoing percutaneous coronary interventions

BACKGROUND

Radial access is preferred in patients with chronic coronary syndromes (CCSs) treated with ad hoc percutaneous coronary intervention (PCI). Antithrombotic and antiplatelet treatment before PCI may affect outcomes at vascular access sites. QuikClot Radial is a kaolin-based band that may shorten hemostasis time. Using point-of-care testing, we investigated the effect of antithrombotic and antiplatelet treatment on access-site complications.

METHODS

This prospective observational study included consecutive patients with CCS on chronic aspirin therapy referred for ad hoc PCI. The activated clotting time (ACT), global thrombosis test and VerifyNow P2Y 12 test were done sequentially after unfractionated heparin (UFH) and clopidogrel administration. Patients were monitored for radial artery patency, bleeding and local hematoma until discharge.

RESULTS

We enrolled 40 patients [mean age, 68.8 ± 8.8 years; men, 30 (75%)] who received UFH (median dose, 8000 IU; interquartile range, 7000-9000 IU) and clopidogrel (600 mg). All radial arteries remained patent during follow-up. Local bleeding and hematomas were noted in 11 patients (27.5%) each. Patients with bleeding had lower mean platelet activity at 2 h [122.5 ± 51 platelet reactivity units (PRU) vs. 158.7 ± 43 PRU, P  = 0.04] and higher ACT (216.9 ± 40 s vs. 184.6 ± 28 s, P = 0.006) than patients without bleeding. An ACT >196 s at 2 h predicted bleeding or hematoma (AUC, 0.72; 95% CI, 0.56-0.85, P = 0.008).

CONCLUSION

Lower platelet activity and higher ACT after PCI were associated with higher bleeding risk at a vascular access site. Point-of-care testing of ACT after the procedure may help identify patients with CCS undergoing PCI who are at higher risk of access-site bleeding.

Preventing and Managing Radial Artery Occlusion following Transradial Procedures: Strategies and Considerations

Τransradial artery access has recently gained widespread acceptance as the preferred approach for coronary angiography and interventions, due to its lower incidence of bleeding and vascular complications compared to transfemoral access. However, thrombotic occlusion of the radial artery has emerged as the most common complication of this method, impeding its use in future interventions, and in the creation of arteriovenous fistulae for hemodialysis patients, or as a graft for coronary artery bypasses grafting. In this comprehensive review, we delve into the anatomy of the radial artery, the pathophysiology and diagnosis of radial artery occlusion, the identification of potential risk factors and, finally, prevention and treatment strategies. We acknowledge that distal transradial access provides an effective alternative for coronary angiography and catheterizations, with a reduced incidence of radial artery occlusion.