Low-dose heparin reduces radial artery injury in transradial cerebral angiography: a 375-case retrospective study.

Background: Transradial cerebral angiography carries a risk of radial artery injury, which may affect subsequent approaches for angiography or endovascular therapy. The role of heparin in mitigating this risk remains controversial.

Objective: To evaluate the efficacy and safety of heparin in preventing radial artery injury with transradial cerebral angiography. Methods: In a single-center retrospective study, we analyzed 375 patients undergoing diagnostic cerebral angiography via the right radial approach between August 2022 and July 2025. Patients were stratified by heparin dose: no heparin (n = 235), low-dose (30 IU/kg, n = 90), or standard-dose (60 IU/kg, n = 50). Primary outcomes included radial artery injury, ecchymosis, pain and ischemic manifestations. Statistical analyses employed Kruskal-Wallis and chi-square tests with Bonferroni correction for multiple comparisons. Results: Radial artery injury was significantly lower with heparin administration (low-dose: 3.3% [3/90]; standard-dose: 2.0% [1/50]) versus no heparin (14.5% [34/235]; both p < 0.0167), with no difference between heparin doses (p = 0.21). No intergroup differences were observed in ecchymosis (2.1% vs. 1.1% vs. 2.0%, p = 0.83) or pain (4.3% vs. 2.2% vs. 2.0%, p = 0.56). Ischemic manifestations (pallor) occurred exclusively in the no-heparin group (3.4%, 8/235; p = 0.088).

Conclusions: Low-dose heparin (30IU/kg) significantly reduces radial artery injury rates without increasing risk of ecchymosis. Routine administration of low-dose heparin through the arterial sheath is recommended to protect radial artery.