Comparison with Hemostatic Devices After Percutaneous Transradial Coronary Intervention to Reduce Radial Artery Occlusion

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Authors (including presenting author) :
Perry Lee, Chan TW, Lau YY, Kwok MK, John Wong
Affiliation :
Coronary Care Unit, Tseung Kwan O Hospital
Introduction :
Compared with transfemoral approach of percutaneous coronary intervention (PCI), transradial approach is much safer and offers more benefit to patients. A meta-analysis review showed a 73% reduction in major bleeding of transradial approach compared with transfemoral approach. Transradial approach can demonstrate cost effectiveness and improvement in patient comfort. In year of 2016-17, transradial approach was used in 80% of PCI patients in Tseung Kwan O Hospital. However, radial artery occlusion (RAO) is the most widely discussed complication of transradial approach. Prolonged compression from hemostatic compression device is one of the factors causing occlusion. In this project, TR-band and Stepty-P were used to achieve wound hemostasis. Assessment was made whether TR-band could reduce RAO.
Objectives :
The primary objectives of this project are to (1) assess local vascular complications when hemostasis devices were applied; (2) evaluate the time taken for complete hemostasis and (3) evaluate the devices impact on patient comfort.
Methodology :
This was a prospective randomized study and PCI patients were assigned to use one of hemostatic compression devices - TR band and Stepty-P. Radial artery patency was evaluated at 24-hour using a reverse Barbeau test utilizing plethysmographic and pulse oximetry evaluation. Outcome assessment included the time taken for complete hemostasis of two hemostatic compression devices at the access site. A verbal pain intensity scale was used for evaluation of patient’s pain level when hemostatic device was applied.
Result & Outcome :
From May to August 2017, 95 PCI patients were randomized to use TR-Band and Stepty-P for hemostatic devices. None of the patients using TR-Band developed RAO while RAO was developed in three patients using Stepty-P after post-PCI 24-hour. Although there was no significant difference between both groups on time taken to hemostasis, seven patients in Stepty-P group developed bleeding or hematoma formation and three patients in TR-Band group were reported only. Five and four patients in Stepty-P group reported severe pain and very severe pain in pain intensity scale assessment respectively. Three patients with TR-Band reported moderate pain. Use of TR-Band for percutaneous transradial coronary intervention is an effective way to achieve wound hemostasis. It can reduce an incidence rate of RAO. TR-Band was also better tolerated by patients on verbal pain intensity scale assessment.

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