Low-dose heparin reduces radial artery injury in transradial cerebral angiography: a 375-case retrospective study

Transradial cerebral angiography carries a risk of radial artery injury, which may affect subsequent approaches for angiography or endovascular therapy. The role of heparin in mitigating this risk remains controversial.

To evaluate the efficacy and safety of heparin in preventing radial artery injury with transradial cerebral angiography. Methods: In a single-center retrospective study, we analyzed 375 patients undergoing diagnostic cerebral angiography via the right radial approach between August 2022 and July 2025. Patients were stratified by heparin dose: no heparin (n = 235), low-dose (30 IU/kg, n = 90), or standard-dose (60 IU/kg, n = 50). Primary outcomes included radial artery injury, ecchymosis, pain and ischemic manifestations. Statistical analyses employed Kruskal-Wallis and chi-square tests with Bonferroni correction for multiple comparisons. Results: Radial artery injury was significantly lower with heparin administration (low-dose: 3.3% [3/90]; standard-dose: 2.0% [1/50]) versus no heparin (14.5% [34/235]; both p < 0.0167), with no difference between heparin doses (p = 0.21). No intergroup differences were observed in ecchymosis (2.1% vs. 1.1% vs. 2.0%, p = 0.83) or pain (4.3% vs. 2.2% vs. 2.0%, p = 0.56). Ischemic manifestations (pallor) occurred exclusively in the no-heparin group (3.4%, 8/235; p = 0.088).

Low-dose heparin (30IU/kg) significantly reduces radial artery injury rates without increasing risk of ecchymosis. Routine administration of low-dose heparin through the arterial sheath is recommended to protect radial artery.