Radial artery thrombosis following transradial coronary angiography: incidence and rationale for treatment of symptomatic patients with low-molecular-weight heparins

Background Transradial access for diagnostic and therapeutic coronary angiography gains more and more popularity because of its advantages over the femoral approach, enhancing patient comfort, reducing bleeding complications and duration of hospital stay. However, these benefits are overshadowed by an increased rate of radial artery (RA) occlusion. There are little data regarding the exact incidence, potential predictors and outcome of post-procedural RA occlusions. Furthermore, there is no clear evidence for the optimal treatment of this complication. Methods In a single-centre prospective observational study, 488 consecutive patients were evaluated by ultrasound the day after transradial cardiac catheterization for signs of RA occlusion. Symptomatic patients with sonographically identified radial artery thrombosis underwent treatment with low-molecular-weight heparin (LMWH) for 4 weeks. Asymptomatic patients did not receive anticoagulation therapy. The primary endpoint was the patency rate of the radial artery at 4 weeks of follow-up. Results Radial artery thrombosis was found in 51 of 488 (10.5%) patients 1 day after transradial cardiac catheterization. 30 (58.8%) patients showed symptoms on access site, whereas 21 (41.2%) did not show any symptoms. After 4 weeks, 26 (86.7%) of the symptomatic patients showed a partial or complete recanalization of the radial artery after treatment with LMWH, compared with 4 (19.1%) of the asymptomatic patients without anticoagulation (P < 0.001). Conclusion Radial artery thrombosis is a frequent complication after transradial coronary angiography. Incidence of RA occlusion is underestimated due to the often asymptomatic clinical course. Treatment of symptomatic RA occlusion with low-molecular-weight heparins significantly increases patency rates after 4 weeks.