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Published on: September 20, 2020
Radial versus femoral access for orally anticoagulated patients
Antonios G Ziakas1, Konstantinos C Koskinas, Stavros Gavrilidis
11st Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
Insights
For patients on warfarin, radial access for cardiac catheterization is as safe and effective as femoral access. Radial access may reduce complications, especially after percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Vascular Access
- Anticoagulation Therapy
Background:
- Optimal cardiac catheterization strategy for patients on long-term oral anticoagulation is undefined.
- Catheterization without warfarin interruption is increasingly feasible and safe.
- Radial vs. femoral access safety and efficacy in anticoagulated patients remain unknown.
Purpose of the Study:
- To prospectively compare radial versus femoral route efficacy and safety.
- To evaluate cardiac catheterization during uninterrupted warfarin therapy.
Main Methods:
- 56 patients on warfarin (INR 1.8-3.5) randomized to femoral (n=29) or radial (n=27) access.
- Procedures included coronary angiography and/or percutaneous coronary intervention (PCI).
- Outcomes: procedural success, major adverse events, access-site, and bleeding complications.
Main Results:
- No significant differences in baseline characteristics, antiplatelet therapy, or INR levels.
- Procedural success: 100% femoral, 96.3% radial (one crossover).
- Access-site complications occurred in 37.5% of femoral PCI patients vs. 0% of radial PCI patients (P=0.034).
Conclusions:
- Radial access is equally efficacious and safe as femoral access for angiography in anticoagulated patients.
- Radial access likely reduces access-site complications in patients undergoing PCI.
- This supports radial access as a preferred route in select anticoagulated patients.
Objectives:
To prospectively compare the efficacy and procedural safety of the radial versus femoral route for cardiac catheterization during uninterrupted warfarin therapy.
Background:
The optimal treatment strategy for cardiac catheterization in patients receiving long-term oral anticoagulation has not been defined. Increasing evidence suggests the feasibility and safety of catheterization without warfarin interruption. However, the relative safety and efficacy of the radial and femoral access in fully anticoagulated patients are unknown.
Methods:
Fifty-six consecutive patients on chronic warfarin treatment with international normalized ratio (INR) between 1.8 and 3.5 were randomized to undergo coronary angiography, alone, or followed by percutaneous coronary intervention (PCI), via the femoral (n = 29) or radial route (n = 27). Procedural success, in-hospital major adverse cardiac and cerebrovascular events, access-site, and bleeding complications were recorded.
Results:
The two groups were well balanced with similar clinical characteristics at baseline. There were no significant differences in preprocedural antiplatelet therapy or in INR levels between the radial and femoral group (2.62 ± 0.7 vs. 2.48 ± 0.6, respectively, P = 0.63). Procedural success was achieved in all femoral patients, whereas one patient in the radial group (3.7%) required crossover to femoral access. Eight patients from the femoral and 10 patients from the radial group successfully underwent PCI. Access-site complications occurred only in patients who underwent PCI: three (37.5%) in the femoral versus none in the radial group (P = 0.034).
Conclusion:
The radial access is as efficacious and safe as the femoral route for coronary angiography in fully anticoagulated patients, but is likely to result in fewer access-site complications in patients who also undergo PCI.
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