title: Patent haemostasis prevents radial artery occlusion in patients with an acute coronary syndrome.
abstract: BACKGROUND
  A haemostatic technique that maintains radial artery flow ("patent haemostasis") following transradial catheterization reduces rates of radial artery occlusion (RAO) in patients with stable coronary disease. It is unclear whether this benefit extends to patients with an acute coronary syndrome (ACS).
  
  
  METHODS
  Patients undergoing inpatient transradial catheterization for an ACS were prospectively enrolled in a consecutive cohort study (n=300). Radial haemostasis was obtained using standard radial compression (cohort 1; n=150) or patent haemostasis (cohort 2; n=150). An end-of-case activated clotting time (ACT) was recorded and radial artery patency assessed within 24 hours of sheath removal by reverse Barbeau's test.
  
  
  RESULTS
  The incidence of RAO was 16.0% following standard radial compression and 5.3% following patent haemostasis (p=0.003). Univariate predictors of RAO were patent haemostasis (OR 0.30; [0.13-0.68], p=0.004), hyperlipidaemia (OR 0.46; [0.21-0.98], p=0.04), history of current smoking (OR 2.86; [1.3-6.0], p=0.015) and longer procedure times (OR 1.03/additional minute; [1.01-1.05], p=0.003). There was no association between the end-of-case ACT and RAO (OR 1.00; [0.9-1.01] p=1.00). After adjusting for covariates, patent haemostasis reduced the risk of RAO by 70% compared to standard compression (OR 0.30; [0.12-0.77], p=0.12). The c-statistic for model discrimination was 0.79 (95% CI [0.71-0.86], p<0.001). Inverse probability treatment weighted analysis also confirmed patent haemostasis as an independent predictor of reduced RAO (OR 0.38 [0.15-0.95], p=0.039).
  
  
  CONCLUSIONS
  Patent haemostasis is highly effective in preventing early RAO in patients with ACS.
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom. Electronic address: simonwilson3@nhs.net.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Wilson
authors.affiliation: Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mitchell
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom.
authors.forename: Timothy J M
authors.initials: TJM
authors.lastname: Gray
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom.
authors.forename: Hoe Jun
authors.initials: HJ
authors.lastname: Loh
authors.affiliation: British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4SB, United Kingdom; Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom.
authors.forename: Nick L
authors.initials: NL
authors.lastname: Cruden
mesh_terms: D054058:Acute Coronary Syndrome / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D017534:Radial Artery / Q000502:physiology*; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Radial artery occlusion; Transradial coronary catheterization