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Forearm hematoma as a complication of transradial coronary intervention: an Indian single-center experience
Sudhanshu Kumar Dwivedi1, Gyanaranjan Nayak1, Akhil Kumar Sharma1
1Department of Cardiology, King George's Medical University Lucknow, Uttar Pradesh 226003, India.
Insights
Forearm hematomas occur in over 10% of transradial coronary interventions. Female gender, multiple attempts, and longer hemostasis predict this common complication.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Forearm hematomas are a frequent complication following transradial coronary interventions.
- Understanding their incidence and predictors is crucial for patient care.
Purpose of the Study:
- To determine the incidence of forearm hematomas after transradial coronary interventions.
- To identify predictors associated with forearm hematoma formation.
Main Methods:
- Prospective study of 1754 patients undergoing transradial angiography/angioplasty.
- Standardized anticoagulation, hydrophilic sheaths, and patent hemostasis protocols were used.
- Hematoma assessment occurred immediately post-procedure, after radial band removal, and the next day, graded by the ESTS scale.
Main Results:
- A forearm hematoma incidence of 10.7% was observed in 187 patients.
- Female gender, multiple puncture attempts, intensive antiplatelet therapy, complex procedures, and longer hemostasis times were significant predictors.
- No patients required vascular or surgical intervention for hematoma complications.
Conclusions:
- Forearm hematomas are a substantial complication of transradial coronary interventions.
- Interventional variables, particularly modifiable ones, are strongly associated with hematoma development.
- Identifying and managing these risk factors can mitigate hematoma burden.
Background:
Forearm hematomas are not uncommon after transradial coronary interventions. The present study describes the incidence and predictors of forearm hematoma formation after transradial coronary interventions.
Methods:
This was a prospective study in 1754 patients undergoing angiography/angioplasty through transradial access. Each procedure was performed using optimum levels of anticoagulation, hydrophilic sheaths, and post-procedural patent hemostasis protocols. Patients were evaluated for forearm hematoma immediately after the procedure, after radial band removal, and on the next day of the procedure. Severity of hematomas was graded according to the Early Discharge after Transradial Stenting of Coronary Arteries Study scale. Univariate and multivariate logistic regression analyses were done to determine the predictors of hematoma formation.
Results:
Mean age of the patients was 56.31 years and 82.2% were males. A total of 1374 (78.3%) patients underwent angioplasty while 380 (21.7%) underwent angiography. Forearm hematoma developed in 187 (10.7%) patients. Grade I hematoma was most common (3.53%) followed by Grade II (3.08%), Grade III (2.83%) and Grade IV (1.25%) hematoma. None of the patients required vascular or surgical interventions for this complication. Female gender, multiple puncture attempts, intensive antiplatelet therapy, complex procedure and longer hemostasis time were significant predictors of forearm hematoma formation post transradial coronary interventions.
Conclusions:
Forearm hematoma developed in substantial proportion of patients undergoing transradial coronary interventions and interventional variables were predominantly associated with hematoma formation. Pre-emptive knowledge of modifiable interventional risk factors can help in reducing the burden of this complication.
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