Association between ACT, Hemostasis Time, and Radial Artery Patency
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This document summarizes a study evaluating the association between activated clotting time (ACT) levels and time to hemostasis and radial artery patency following radial artery catheterization. The study found that higher ACT levels were weakly correlated with longer times to hemostasis, with a difference of only 10 minutes between low and high ACT groups. ACT levels were not significantly associated with radial artery patency. The conclusions were that ACT levels do not have a clinically significant impact on outcomes and that there is no need to consider protamine sulfate treatment following radial procedures.
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Association between ACT, Hemostasis Time, and Radial Artery Patency
- 1. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Association between activated clotting time and time to hemostasis and radial artery patency Marianne Hestbjerg Poulsen, RN, Department of Cardiology, Aarhus University Hospital, Denmark
- 2. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Disclosures: Terumo has provided an unrestricted grant for the ACCESS-I study
- 3. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Background: Heparin is routinely used during radial artery access. There is limited data on the association between activated clotting time (ACT) and 1) time to hemostasis 2) radial artery patency
- 4. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Purpose: To evaluate the association between ACT and 1) time to hemostasis 2) radial artery patency Study design: Prospective study (substudy of the ACCESS-I study)
- 5. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Methods: We prospectively registered: 1. Medication prior to or during the procedure 2. ACT level just before sheath removal 3. Time of sheath removal 4. Time of hemostasis (when the TR band was removed at the ward) 5. Reverse Barbeau test following removal of the TR band
- 6. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Methods: Removal of the TR-band: 1. At the cath.lab. we registered total volume air inflated in the TR band 2. At the ward 25% of the volume was deflated every 15 minutes 3. If bleeding occured 25% volume was inflated again 4. We repeated 2 and 3 until the TR-band could be removed
- 7. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Methods: Reverse Barbeau test:
- 8. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Study population: 1000 patients randomised to slender versus standard sheath in the ACCESS-I study (15 december 2015 to 12 july 2016) 891 patients included at Aarhus University Hospital Valid ACT levels in 789 (88%) patients Time to hemostasis in 747 (84%) Reverse Barbeau in 695 (78%)
- 9. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Medication: =789
- 10. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Mean time to hemostasis (minutes) N ACT≤250 ACT 251-300 ACT>300 P All patients 747 pts. 143 min. 152 min. 153 min. 0.09 Association between ACT and time to hemostasis: Spearman rho=0.08, P=0.02 Results:
- 11. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Reverse Barbeau N=695 ACT ≤ 250 ACT 251-300 ACT > 300 A 269 (87.6%) 171 (81.8%) 140 (78.2%) B 26 (8.5%) 31 (14.8%) 31 (17.3%) C 6 (2.0%) 3 (2.8%) 5 (2.8%) D 6 (2.0%) 4 (1.9%) 3 (1.7%) P=0.11 Association between ACT and radial artery patency:
- 12. Departmnt of Anesthesia and Intensive Care Medicine Temadag Maj 2016Department of Cardiology Conclusions: Activated clotting time following radial angiography or angioplasty is associated with time to hemostasis, but the limited difference in time to hemostasis (10 min) between patients with low versus high ACT is not clinical relevant Perspectives: No reason to consider protamine sulphate following radial angiography or angioplasty
Editor's Notes
- Mr. Chairmann, ladies and geneltmen, I thank the organising committee for giving me the opportunity to present our study. The title of the study is ….
- We included 1000 patients in the ACCESS-I study during a 7 month study period from …. To …. XX patietns were included at our institution …. And of these patients data on ACT was available in 804 patients corrponding to XX% These 804 patients comprise the current study population
- ADP blocker = clopidogrel eller brilique (ticagrelor) eller efient (prasugrel) ADP-receptor blocker = Adenosin Di-phosphat receptror blocker Bivalirudin = Angiox Abciximab = Rheopro NOAC/AK: pradaxa, xarelto, elequis
- Thank you