Randomized Trial of Compression Duration After Transradial Cardiac Catheterization and Intervention.
Radial artery occlusion is a known complication following transradial cardiac catheterization. A shorter duration of postprocedural radial clamp time may reduce radial artery occlusion (RAO) but might be associated with incomplete hemostasis.



In total, 568 patients undergoing transradial diagnostic cardiac catheterization were randomly assigned to either 20 minutes (ultrashort) or 60 minutes (short) hemostatic compression time using patent hemostasis. Subsequently, clamp pressure was reduced gradually over 20 minutes. Access site hemostasis and RAO were assessed after clamp removal. Repeated assessment of RAO was determined at 1 week in 210 (37%) patients. Mean age was 64±11 years, and 30% were female. Percutaneous coronary intervention was performed in 161 patients. RAO immediately after clamp removal was documented in 14 (4.9%) and 8 (2.8%) patients in the 20- and 60-minute clamp application groups, respectively (P=0.19). The incidence of grade 1 hematoma was higher in the 20-minute group (6.7% versus 2.5%, P=0.015). RAO at 1 week after the procedure was 2.9% and 0.9% in the 20- and 60-minute groups, respectively (P=0.36). Requirement for clamp retightening (36% versus 16%, P=0.01) was higher among patients who had RAO. Need for clamp retightening was the only independent predictor of RAO (P=0.04).



Ultrashort radial clamp application of 20 minutes is not preferable to a short duration of 60 minutes. The 60-minute clamp duration is safe and provides good access site hemostasis with low RAO rates.



URL: http://www.clinicaltrials.gov. Unique identifier: NCT02269722.
London Health Sciences Centre, London, Ontario, Canada shahar.lavi@lhsc.on.ca.|Western University, London, Ontario, Canada.
Shahar
S
Lavi
St. Michael's Hospital, Toronto, Ontario, Canada.|University of Toronto, Ontario, Canada.
Asim
A
Cheema
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Andrew
A
Yadegari
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Zeev
Z
Israeli
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Yaniv
Y
Levi
London Health Sciences Centre, London, Ontario, Canada.
Sabrina
S
Wall
London Health Sciences Centre, London, Ontario, Canada.
Mistre
M
Alemayehu
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Yasir
Y
Parviz
London Health Sciences Centre, London, Ontario, Canada.
Bogdan-Dorian
BD
Murariu
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Terry
T
McPherson
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Jaffer
J
Syed
London Health Sciences Centre, London, Ontario, Canada.|Western University, London, Ontario, Canada.
Rodrigo
R
Bagur
D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011312:Pressure; D011677:Punctures / Q000009:adverse effects*; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D014654:Vascular Patency
angiography; cardiac catheterization; percutaneous coronary intervention; vascular complications