title: Frequency of radial artery occlusion after transradial access in patients receiving warfarin therapy and undergoing coronary angiography.
abstract: The efficacy of warfarin-induced anticoagulation in reducing radial artery occlusion (RAO) after transradial access is not known. The present case-control study compared the incidence of early (24 hours) and late (30 days) RAO in patients undergoing transradial diagnostic coronary angiography during therapeutic warfarin anticoagulation (group 1) with that of a matched (3:1) cohort of patients not receiving warfarin and receiving intraprocedural heparin (group 2). All patients underwent transradial diagnostic coronary angiography using a 5F hydrophilic introducer sheath. The patients in group 2 received an intravenous heparin bolus (50 IU/kg) immediately after sheath insertion. After sheath removal, hemostasis was obtained using the TR-band (Terumo Interventional Systems, Terumo Medical, Tokyo, Japan) and a plethysmography-guided patent hemostasis technique. We included 86 patients receiving warfarin with an international normalized ratio of 2 to 4 in group 1 and 250 matched patients in group 2. No significant differences were present in the demographic and procedural variables between the 2 groups. Early RAO occurred in 18.6% of the patients in group 1 compared with 9.6% of patients in group 2 (p = 0.024). The incidence of late RAO remained significantly higher in group 1 compared with group 2 (13.9% vs 5.2%, p = 0.01). All patients with RAO remained asymptomatic. In conclusion, patients receiving chronic oral anticoagulation with warfarin and undergoing transradial coronary angiography without parenteral anticoagulation had a higher incidence of early and late RAO compared with patients receiving standard intravenous heparin therapy.
authors.affiliation: The Wright Center for Graduate Medical Education and The Commonwealth Medical College, Scranton, Pennsylvania. Electronic address: pancholys@gmail.com.
authors.forename: Samir B
authors.initials: SB
authors.lastname: Pancholy
authors.affiliation: The Wright Center for Graduate Medical Education and The Commonwealth Medical College, Scranton, Pennsylvania.
authors.forename: Imdad
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Quebec Heart-Lung Institute, University Laval, Quebec City, Quebec, Canada.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: Apex Heart Institute, Seth N.H.L. Municipal Medical College, Ahmedabad, India.
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006328:Cardiac Catheterization / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin