Key result
Higher-dose UFH is not linked to lower RAO risk versus 50 IU/kg in distal access.
Why the study?
The effect of a higher dose of unfractionated heparin on radial artery occlusion incidence in patients undergoing coronary procedures via distal radial access remains unclear.
Does a higher dose of unfractionated heparin (≥70 IU/kg) reduce radial artery occlusion incidence in patients undergoing coronary procedures via distal radial access?
Observational (n=379)
Does a higher dose of unfractionated heparin (≥70 IU/kg) reduce radial artery occlusion incidence in patients undergoing coronary procedures via distal radial access?
Absolute Event Rate: 3.3% vs 3.4%
p-value: p=0.957
Increasing the dose of unfractionated heparin to ≥70 IU/kg does not appear to reduce the incidence of radial artery occlusion in patients undergoing coronary procedures via distal radial access compared to a 50 IU/kg dose.
Higher heparin dosing does not appear to reduce radial occlusion in distal access; hypothesis-generating and should not yet change practice.
Background Radial artery occlusion (RAO) is the most common complication following coronary catheterization. Several measures have been taken to prevent RAO, including increasing the dose of unfractionated heparin (UFH) and using a distal radial artery (DRA) approach. However, the effect of a higher dose of UFH on RAO incidence in the DRA approach remains unclear. Purpose This study aims to investigate the impact of heparin dose (50IU/kg or ≥70IU/kg) after DRA approach on RAO incidence. Methods Data were obtained from a previous randomized controlled trial comparing distal to conventional radial access regarding RAO. Patients having undergone DRA access were stratified into two groups based on heparin dose received. A Pearson chi-square test was used to compare RAO incidence between the groups, and a multivariate logistic regression analysis was performed, considering baseline and periprocedural details. Results Data on RAO incidence and heparin dose were available for 768 patients, and 379 catheterized via DRA. A total of 234 patients received ≥70IU/kg heparin dose and the rest 145 received 50IU/kg. A higher dose of UFH was not associated with a lower incidence of RAO (3.3% vs. 3.4%, p=0.957). Multivariate logistic regression analysis showed that the use of 5-Fr sheaths (odds ratio [OR]: 0.044, 95% CI: 0.003-0.755), a lower number of diagnostic catheters (OR: 2.47, 95% CI: 1.250-4.878), and a shorter total procedure time (OR: 1.034, 95% CI: 1.011-1.059) were significantly associated with lower rates of RAO. Conclusions Our analysis indicates that a higher dose of UFH (≥70IU/kg) did not reduce RAO incidence in DRA access. Further studies with larger sample sizes are necessary to confirm these findings.
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Tsigkas et al. (2023) conducted an observational in Coronary procedures via distal radial access (n=379). Higher dose unfractionated heparin (UFH) vs. 50IU/kg was evaluated on Radial artery occlusion (RAO) incidence (p=0.957). A higher dose of unfractionated heparin (≥70IU/kg) did not reduce the incidence of radial artery occlusion compared to 50IU/kg in patients undergoing distal radial access (3.3% vs. 3.4%, p=0.957).
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