Coronary Artery Disease Clinical Trial
Official title:
Comparison of A-priori Versus Provisional Heparin Therapy on Radial Artery Occlusion After Transradial Coronary Angiography and Patent Hemostasis
The Provisional Heparin TherApy on Radial Artery Occlusion after transradial coronary angiography and patent Hemostasis (PHARAOH) study compares the strategy of standard a-priori heparin use in patients undergoing transradial coronary angiography to a strategy of provisional heparin administration only if patent hemostasis is not achievable.
Transradial access use for coronary angiography and intervention is increasing. Its efficacy
in lowering access site complications, as well as increased patient comfort, has been proven
unequivocally. One of the complications of transradial access is radial artery occlusion
(RAO) that occurs with a variable incidence. It is population specific, with a higher
prevalence in subsets, such as women, and patient's with small radial arteries. RAO is also
known to be higher at hospital discharge and radial recanalization may spontaneously occur
at later times. It is usually asymptomatic. Its main adverse impact is by limiting future
transradial access from that radial artery. Since most of the patient's with atherosclerotic
vascular disease may undergo several invasive procedures during their lifetime, prevention
of RAO is of paramount importance.
Heparinization, during the procedure, has been shown to be of benefit in lowering the
incidence of RAO. Maintaining patency of the radial artery during hemostasis, has also been
shown to be effective in prevention of RAO following transradial access. As maintenance of
flow has potent antithrombotic effect, it is unclear whether systemic anticoagulation is
still required in all cases.
In some cases, it would be preferable to avoid heparin administration prior to coronary
angiography. It is currently unknown whether it would be safe to refrain from heparin
administration in case of transradial catheterization and patent hemostasis technique.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
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