Patent haemostasis prevents radial artery occlusion in patients with an acute coronary syndrome

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). Conclusion: Patent haemostasis is highly effective in preventing early RAO in patients with ACS. (C) 2017 Elsevier B.V. All rights reserved.