Objective To systematically compare and rank the effectiveness of different procoagulants and radial artery compression methods in achieving successful haemostasis and improving vascular outcomes following radial artery catheterization. Methods A systematic strategy was employed to identify published and unpublished clinical trials from PubMed, CINAHL, Scopus, Web of Science, Embase and Cochrane Trials until March 2025. A network meta‐analysis was conducted to compare the relative effectiveness of the interventions using frequentist framework and random effects model using the MetaInsight software. Results Fourteen clinical trials involving 6661 participants were included. In direct comparisons, kaolin dressings applied for 120 min had successful haemostasis compared with standard bandage (RR 1.11, 95% CI 1.01–1.21, very low certainty), while potassium ferrate hydrophilic polymer (PFHP) combined with a pneumatic compression device (PCD) for 60 min was superior to PCD alone for 60 min (RR 2.49, 95% CI 2.26–2.75, very low certainty). Several procoagulants significantly reduced time to haemostasis compared with PCD for 120 min, including kaolin (30 min: MD –118.7 min, 95% CI −198.9 to −38.5 moderate certainty; 60 min: MD −88.5 min, 95% CI −168.7 to −8.3, very low certainty), chitosan (60 min: MD −113.0 min, 95% CI −212.6 to −13.3, moderate certainty) and PFHP + PCD (60 min: MD −96.1 min, 95% CI −148.9 to −43.3, low certainty). Chitosan dressings (60 min) reduced the risk of radial artery occlusion (RAO) compared with PCD for 60 min (RR 0.49, 95% CI 0.28–0.85, moderate certainty). Network meta‐analyses were frequently fragmented, and no intervention demonstrated superiority over PCD for 120 min for successful haemostasis, haematoma, bleeding or RAO. Study numbers per outcome were limited, and heterogeneity was substantial, resulting in low certainty of evidence; findings should therefore be interpreted as hypothesis‐generating rather than practice‐defining. Conclusion Several procoagulants significantly improve haemostasis following radial artery catheterization and may be integrated into clinical practice to optimize patient outcomes. However, the findings should be interpreted with caution due to substantial clinical and methodological heterogeneity across included trials, the limited number of studies contributing to several comparisons, and the overall low certainty of evidence for key outcomes. Further studies are warranted to corroborate and refine these findings for routine application.
Fernandez et al. (Thu,) studied this question.