title: Percutaneous left and right heart catheterization in fully anticoagulated patients utilizing the radial artery and forearm vein: a two-center experience.
abstract: BACKGROUND
  Stopping oral anticoagulants prior to cardiac catheterization is associated with an increased risk of thromboembolism. Performing the procedures via the femoral artery and vein without interruption of anticoagulation is associated with a high rate of major access site complications. The transradial technique for left heart catheterization is safe in fully anticoagulated patients but few data are available on the percutaneous right and left heart catheterization utilizing a combination of the radial artery and antecubital vein in this group of patients.
  
  
  METHODS
  We report our experience in 28 consecutive patients that underwent left and right heart catheterizations via this percutaneous arm approach without interruption of anticoagulation. These were compared to 31 consecutive non-anticoagulated patients that underwent the procedure via a conventional femoral artery and vein approach.
  
  
  RESULTS
  Arterial and venous accesses were achieved and complete angiographic and hemodynamic data obtained in all patients. There were no access site complications in the anticoagulated patients despite an International normalized ratio (INR) of 2.5 +/- 0.5. Procedural duration was longer in the anticoagulated group of patients, but fluoroscopy time and patient radiation dose were similar in both groups.
  
  
  CONCLUSIONS
  Our experience suggests that left and right heart catheterization can be safely performed in most fully anticoagulated patients using this technique with a low bleeding and thromboembolic risk and no increase in radiation exposure.
authors.affiliation: Cardiothoracic Centre, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom.
authors.forename: Ted S N
authors.initials: TS
authors.lastname: Lo
authors.forename: Ashesh N
authors.initials: AN
authors.lastname: Buch
authors.forename: Ian R
authors.initials: IR
authors.lastname: Hall
authors.forename: David J
authors.initials: DJ
authors.lastname: Hildick-Smith
authors.forename: James
authors.initials: J
authors.lastname: Nolan
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery; D005542:Forearm; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D014680:Veins
chemical_list: D000925:Anticoagulants