Safe and Fast Radial Artery Hemostasis Using Synergistic Strategies: SAFE and FAST Trial.
TL;DR
A strategy of using a lower dose of heparin with UC achieves shorter duration hemostasis after TRA with significantly less rebound bleeding and RAO, as compared with the conventional strategy.
Abstract
Transradial access (TRA) has been increasingly utilized for cardiac catheterization. Pursuit of faster patient throughput has generated a need for more rapid hemostasis protocols that are safe, effective and affordable. Patients undergoing diagnostic cardiac catheterization using TRA at two tertiary-care centers were randomized to receive the standard of care procedure utilizing 5/6 French hydrophilic introducer sheath, with 50 units/kg of heparin during the procedure and a 2-hour hemostatic compression using a single-balloon device (Group 1), or 25 units/kg of heparin, with 1-hour hemostatic compression using a dual-balloon device capable of simultaneous ipsilateral ulnar artery compression (UC) (Group 2). The primary study endpoint was a composite of radial artery occlusion (RAO), rebound bleeding or hematoma formation. 451 patients were randomized: 224 in Group 1 and 227 in Group 2. A significant reduction in the primary endpoint was observed in Group 2 as compared with Group 1 (4% vs 10.3%, P = 0.01). Patent hemostasis was achieved in 97% of patients in Group 2, compared with 81% in Group 1 P = 0.001), with fewer nursing visits in Group 2 (5.3 ± 0.8 vs 3.1 ± 0.3, P = 0.001). Group 2 patients also achieved successful hemostasis with a significant reduction in duration of compression (mean reduction = 62 minutes, P = 0.001). In conclusion, a strategy of using a lower dose of heparin with UC achieves shorter duration hemostasis after TRA with significantly less rebound bleeding and RAO, as compared with the conventional strategy.