Effectiveness and Safety of 4-Fr Distal Radial Access With Low-Dose Unfractionated Heparin Versus Proximal Radial...

A minimum of 2 h is required to achieve hemostasis after coronary angiography via a radial approach.

To evaluate an initial minimalist approach for scheduled coronary angiography, combining 4-Fr distal radial access with low-dose (2000 IU) unfractionated heparin (UFH) (4DRA).

This prospective cohort study enrolled consecutive outpatients undergoing scheduled diagnostic coronary angiography (November 2023 to November 2024). For distal radial access, a 4 Fr introducer was first used, with intravenous injection of low-dose UFH (2000 IU; 4DRA group). For proximal radial access, a 4-6 Fr introducer was used, with intravenous injection of standard-dose UFH (50 IU/kg; PRA group). The primary outcome was hemostasis time. Secondary safety outcomes were the rate of definite proximal radial artery occlusion (RAO), Grade ≥ II hematomas, examination metrics, puncture failure rate, and technical failure.

One thousand three hundred eight-two consecutive patients were enrolled (632 4DRA, 750 PRA). Median hemostasis time was lower in 4RDA versus PRA (30 min [interquartile range: 10-111 min] vs. 140 min [120-180 min], respectively; p < 0.001). This time difference was driven by patients who had a diagnostic coronary angiography (20 min [interquartile range: 5-30 min] vs. 135 min [120-160 min]). Proximal RAO was lower in 4DRA (0.2 vs. 1.1%; p = 0.04). Rates of Grade ≥ II hematomas (1.6 vs. 2.3%; p = 0.4) and technical failure (3.2 vs. 3.7%; p = 0.6) were low and were similar between groups.

An initial 4-Fr distal radial approach combined with low-dose UFH results in a substantial reduction in hemostasis time while also demonstrating an excellent safety profile.