The Efficacy of Hemostatic Agents on Radial Artery Compression Methods Following Transradial Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Radial artery hemostasis in patients undergoing transradial procedures can be achieved through various compression methods, including manual or mechanical devices, with or without the use of hemostatic agents, and may involve patent hemostasis or concomitant ulnar compression. Previous findings suggest that radial artery compression should be maintained for 120 minutes post-procedure. However, the optimal compression method and the efficiency of hemostatic agents remain uncertain. Therefore, we decided to perform a systematic review and meta-analysis evaluating the efficacy of radial artery compression with adjunctive hemostatic agents versus compression without hemostatic agents on patients following transradial procedures. The systematic search was conducted using PubMed, Embase, and Cochrane Central databases. The outcomes evaluated were: time to achieve hemostasis (TAH), failure to achieve hemostasis (FAH), 24-hour radial artery occlusion (24-RAO), and hematoma occurrence. We performed subgroup analyses separating manual and mechanical compression with hemostatic agents. 13 randomized controlled trials were included, comprising 6,588 patients. 2,924 (44.4%) patients underwent compression with hemostatic agents, and 3,664 (55.6%) underwent compression without hemostatic agents. The statistical analysis indicated that hemostatic agents were associated with a significantly reduced TAH (MD -86.59 min; 95% CI -106.88 to -66.30; p < 0.01) compared to compressions without hemostatic agents. No statistical difference was found between the methods regarding 24-RAO, FAH, and hematoma occurrence. However, subgroup analyses revealed that, in the manual compression with hemostatic agents subgroup, 24-RAO was also significantly reduced (RR 0.46; 95% CI 0.27 to 0.78). In conclusion, this meta-analysis of randomized controlled trials reveals that compression with hemostatic agents, compared to compressions without hemostatic agents, can reduce TAH without compromising the occurrence of hematomas for patients following transradial procedures. 24-RAO was also less frequent in patients who underwent manual compression with hemostatic agents.