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Catheter Cardiovasc Interv. 2018 Nov 1;92(5):854-859. doi: 10.1002/ccd.27530. Epub 2018 Feb 6.

Heparin use for diagnostic cardiac catheterization with a radial artery approach: An international survey of practice patterns.

Author information

1
Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
2
Population Health Research Institute, McMaster University Hamilton Health Sciences, Hamilton, Ontario, Canada.
3
Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada.
4
Duke Clinical Research Institute, Durham, North Carolina.
5
Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
6
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
7
York Clinical Cardiology, Southlake Regional Health Centre, Vaughan, Ontario.
8
Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.

Abstract

OBJECTIVES:

We aimed to describe global practice patterns of unfractionated heparin (UFH) use for diagnostic transradial cardiac catheterization.

BACKGROUND:

The use of the radial artery approach for cardiac catheterization is increasing globally. Limited contemporary data exist to support the use or optimal dosing of UFH to prevent radial artery occlusion (RAO) and other thromboembolic complications.

METHODS:

We performed a web-based international survey of 450 interventional cardiologists from 34 countries. We collected information regarding the experience and use of UFH for diagnostic transradial cardiac catheterization.

RESULTS:

The survey was conducted between June and July 2016 and was completed by 227 (50.4%) interventional cardiologists. Overall, 83.3% performed >75% of their coronary angiograms via a radial approach, with the plurality (41.9%) having 10-20 years of clinical experience. Of all respondents, 7.5% did not use UFH for routine diagnostic transradial heart catheterization. Of the 92.5% who did use UFH, it was preferentially administered intra-arterially by 60% and intravenously by 40%. The majority (62.6%) of interventionalists used a fixed UFH dose with 5,000 IU being the most common dose (used in 48%). For those using a weight-based UFH (50 IU/kg) dosing regimen for diagnostic procedures (36.1%), the administered UFH dose ranged from 2,000 up to 10,000 IU.

CONCLUSIONS:

Despite the lack of firm evidence, the majority of interventional cardiologists who participated in the survey use UFH to prevent RAO for diagnostic transradial coronary angiography. However, there exist large practice disparities with regards to dose and route of administration. Given this knowledge gap, a dedicated randomized trial is warranted.

KEYWORDS:

angiography; anticoagulation; heparin; radial approach; radial artery; survey

PMID:
29405556
DOI:
10.1002/ccd.27530

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