PMID- 29223499
OWN - NLM
STAT- MEDLINE
DCOM- 20190722
LR  - 20190722
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 19
IP  - 5 Pt B
DP  - 2018 Jul-Aug
TI  - A comparison of standard versus low dose heparin on access-related complications 
      after coronary angiography through radial access: A meta-analysis of randomized 
      controlled trials.
PG  - 575-579
LID - S1553-8389(17)30409-8 [pii]
LID - 10.1016/j.carrev.2017.10.018 [doi]
AB  - BACKGROUND: Transradial access (TRA) is preferred for coronary angiography (CA) 
      or percutaneous coronary intervention due to reduced access-related 
      complications, and mortality especially for patients with ST elevation myocardial 
      infarction. Radial artery occlusion (RAO) is a known complication of TRA, and 
      precludes its use as a future access site, conduit for coronary artery bypass 
      grafting or for hemodialysis fistula placement. Although a standard dose (SD) 
      heparin of 5000 Units is used during TRA, the risks of RAO and hematoma compared 
      to lower dose (LD) remain unclear. To compare the risks of RAO and hematoma using 
      SD vs. LD heparin after CA through TRA, we performed a meta-analysis of 
      randomized controlled trials (RCT). METHODS: We searched PubMed, EMBASE, CINAHL 
      and CENTRAL for RCTs since inception through 06/30/2017 and used random effects 
      model for analysis. The outcomes analyzed were RAO, hematoma formation and radial 
      artery compression time (RACT). RESULTS: We identified a total of 6 RCTs with a 
      total of 2239 patients. SD heparin resulted in a trend toward a lower risk of RAO 
      [4.2% vs. 10.7%; risk ratio (RR): 0.40, 95% confidence interval (CI): 0.16-1.0; 
      P=0.05], a trend toward increased risk of hematoma [2.2% vs. 1.1%; 1.83 
      (0.91-3.66); P=0.09], and a longer duration of RACT [mean difference: 9.64min 
      (4.01-15.28); P=0.0008] compared to LD. CONCLUSIONS: The current meta-analysis 
      showed a trend towards reduction in the risk of RAO with the use of standard dose 
      heparin. Larger randomized trials should explore the appropriate dosing of 
      heparin to prevent radial artery occlusion.
CI  - Published by Elsevier Inc.
FAU - Dahal, Khagendra
AU  - Dahal K
AD  - Division of Cardiology, Department of Medicine, Louisiana State University Health 
      Science Center, Shreveport, LA, USA.
FAU - Sharma, Sharan
AU  - Sharma S
AD  - Department of Medicine, University of New England, LRGHealthcare, Laconia, NH, 
      USA.
FAU - Yousuf, Adil
AU  - Yousuf A
AD  - Division of Cardiology, Department of Medicine, Louisiana State University Health 
      Science Center, Shreveport, LA, USA.
FAU - Lee, Juyong
AU  - Lee J
AD  - Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, 
      CT, USA.
FAU - Azrin, Michael
AU  - Azrin M
AD  - Calhoun Cardiology Center, University of Connecticut Health Center, Farmington, 
      CT, USA.
FAU - Jimenez, Enrique
AU  - Jimenez E
AD  - Section of Cardiology, Overton Brooks Veteran Affairs Medical Center, Shreveport, 
      LA, USA.
FAU - Modi, Kalgi
AU  - Modi K
AD  - Division of Cardiology, Department of Medicine, Louisiana State University Health 
      Science Center, Shreveport, LA, USA.
FAU - Tandon, Neeraj
AU  - Tandon N
AD  - Section of Cardiology, Overton Brooks Veteran Affairs Medical Center, Shreveport, 
      LA, USA. Electronic address: neeraj.tandon@va.gov.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20171105
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Cardiovasc Revasc Med. 2018 Jul - Aug;19(5 Pt B):558-560. PMID: 30146117
MH  - Aged
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Cardiac Catheterization/*adverse effects/methods
MH  - Catheterization, Peripheral/*adverse effects/methods
MH  - Coronary Angiography/*adverse effects/methods
MH  - Female
MH  - Hematoma/chemically induced
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Peripheral Arterial Disease/diagnostic imaging/etiology/*prevention & control
MH  - Punctures
MH  - *Radial Artery/diagnostic imaging
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Coronary angiography
OT  - Heparin
OT  - Radial artery access
OT  - Radial artery occlusion
EDAT- 2017/12/11 06:00
MHDA- 2019/07/23 06:00
CRDT- 2017/12/11 06:00
PHST- 2017/09/19 00:00 [received]
PHST- 2017/10/29 00:00 [revised]
PHST- 2017/10/31 00:00 [accepted]
PHST- 2017/12/11 06:00 [pubmed]
PHST- 2019/07/23 06:00 [medline]
PHST- 2017/12/11 06:00 [entrez]
AID - S1553-8389(17)30409-8 [pii]
AID - 10.1016/j.carrev.2017.10.018 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2018 Jul-Aug;19(5 Pt B):575-579. doi: 
      10.1016/j.carrev.2017.10.018. Epub 2017 Nov 5.