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.

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