Document Detail


Coronary angiography in the fully anticoagulated patient: the transradial route is successful and safe.
MedLine Citation:
PMID:  12508189     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The radial approach to coronary angiography is intuitively attractive for fully anticoagulated patients (INR > 2) but no data exist concerning efficacy or safety of this procedure. The consensus view is that the femoral approach is contraindicated in fully anticoagulated patients, and though some operators undertake femoral catheterization in such patients and use closure devices, there are no data to suggest that it is safe to do so. At our institution, the radial approach for coronary angiography is reserved for patients in whom there is a relative contraindication to the femoral route. We have undertaken over 600 radial coronary angiograms in such patients since 1996, 66 of whom underwent transradial catheterization specifically because of anticoagulation status (INR > 2). Thirty-eight patients (58%) were male, average age 67 +/- 11 years. All 66 patients had an INR > 2 but < 4.5. The approach was left radial in 26 (39%), right radial in the remainder; sheath size was 4 Fr in 4 (6%), 5 Fr in 13 (20%), and 6 Fr in 49 (74%). Seven operators in total were involved, though two operators undertook the majority of cases (47; 71%). Success rate was 97%, with no failure of access, and only one minor postprocedural hemorrhage. Failures were due to radial artery atherosclerosis (1) and subclavian tortuosity (1). The radial approach to coronary angiography is safe and to be recommended in the fully anticoagulated patient.
Authors:
David J R Hildick-Smith; John T Walsh; Martin D Lowe; Michael C Petch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  58     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2002-12-31     Completed Date:  2003-04-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  8-10     Citation Subset:  IM    
Copyright Information:
Copyright 2003 Wiley-Liss, Inc.
Affiliation:
Department of Cardiology, Papworth Hospital, Cambridgeshire, UK. djrhs@waitrose.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / adverse effects,  therapeutic use*
Coronary Angiography / adverse effects*,  contraindications
Coronary Disease / drug therapy*,  radiography*
Female
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Postoperative Complications*
Radial Artery / drug effects,  radiography,  surgery*
Retrospective Studies
Vascular Diseases / etiology*
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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