title: Access-site bleeding and radial artery occlusion in transradial primary percutaneous coronary intervention: influence of adjunctive antiplatelet therapy.
abstract: BACKGROUND
  The aim of this study was to evaluate access-site complications in patients with ST-segment elevation myocardial infarction treated with a transradial primary percutaneous coronary intervention relative to three different P2Y12 platelet inhibitors.
  
  
  METHODS
  We enrolled 334 consecutive patients (76.9% men, age: 59.4±9.1 years) treated by one of the following: clopidogrel (n=118), prasugrel (n=102), and ticagrelor (n=114). The use of the IIb/IIIa inhibitor, abciximab, was left to the operators' discretion. The time needed to achieve patent hemostasis, compression time, and local complications were analyzed.
  
  
  RESULTS
  The baseline characteristics were similar in all three P2Y12 platelet inhibitor groups. Abciximab was used in 72 (21.6%) patients. Administration of abciximab was associated with a higher incidence of grade II and III hematomas (23.6 vs. 5.0%, P<0.0001, and 5.6 vs. 1.1%, P=0.041, respectively). Among different platelet P2Y12 receptor inhibitor groups, the incidences of hematomas grade II and III were similar in patients who did (P≥0.14) and did not (P≥0.31) receive abciximab. There were no grade IV or V hematomas in any of the groups. Patent hemostasis was achieved faster (24.5±13.4 vs. 43.5±30.0 min, P<0.0001) and compression time was shorter (113.2±53.6 vs. 217.8±115.5 min, P<0.0001) when abciximab was not used. Radial artery occlusion occurred in one (0.3%) patient.
  
  
  CONCLUSIONS
  After transradial primary percutaneous coronary intervention, early patent hemostasis and short artery compression times were associated with a higher incidence of local hematomas. The incidence of hematomas was dependent on the use of abciximab, but unrelated to the type of P2Y12 inhibitor used. All hematomas were without clinical consequences.
authors: aDepartment of Cardiology, University Hospital bDepartment of Internal Medicine II cBiomedical Centre, Faculty of Medicine in Pilsen, Charles University, Plzeň, Czech Republic.
authors: Milan
authors: M
authors: Hromádka
authors: Ivo
authors: I
authors: Bernat
authors: Jitka
authors: J
authors: Seidlerová
authors: Štěpán
authors: Š
authors: Jirouš
authors: Eva
authors: E
authors: Dragounová
authors: Vratislav
authors: V
authors: Pechman
authors: Pavlína
authors: P
authors: Tůmová
authors: Richard
authors: R
authors: Rokyta
mesh_terms: D000077284:Abciximab; D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D000077144:Clopidogrel; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006489:Hemostatic Techniques; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000187:drug effects; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects; D011677:Punctures; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects*; D017534:Radial Artery / Q000000981:diagnostic imaging; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D000077284:Abciximab