BACKGROUND Radial artery occlusion (RAO) is a thrombotic complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Sheath-vessel diameter ratio, postprocedure compression time, occlusive hemostasis, and insufficient anticoagulation are all predictors of RAO. However, excessive anticoagulation can lead to longer time to achieve complete hemostasis and less patent hemostasis rate. This study was designed to assess the relationship among residual anticoagulation at the end of a percutaneous coronary procedure and the risk of RAO. METHODS Eight hundred thirty-seven patients undergoing transradial catheterization were enrolled. Activated clotting time (ACT) was measured before sheath removal. Patients were divided into 3 groups according to ACT values (ACT <150 s, ACT between 150 and 249 s, ACT >250 s), patent hemostasis with reverse Barbeau test was attempted in all patients, and compression device removed as soon as possible. Within 24 hours, patency of radial artery was checked by Doppler using reverse Barbeau technique. RESULTS Incidence of RAO was higher for the extreme ACT values. Patent hemostasis were less frequently obtained and time to hemostasis significantly longer for increasing ACT values (P=0.004 for trend and <0.0001 for trend, respectively). At logistic regression analysis, ACT values <150 s were an independent predictor of RAO (odds ratio, 3.53; 95% IC, 1.677-7.43; P=0.001) while adjusted probability for RAO confirmed U-shaped relationship with ACT values. CONCLUSIONS The level of anticoagulation is strongly related to incidence of RAO and should be measured objectively by ACT. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02762344.

中文翻译：

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活化凝血时间悖论：活化凝血时间与the动脉闭塞作为经皮冠状动脉手术的血管通路时的关系。

背景技术Rad动脉阻塞（RAO）是经of动脉导管插入术的血栓形成并发症，其可导致permanent动脉的永久阻塞。鞘管直径比，术后压缩时间，闭塞止血和抗凝作用不足都是RAO的预示因素。但是，过度的抗凝可能导致更长的时间来实现完全止血和更少的专利止血率。这项研究旨在评估经皮冠状动脉手术结束时残留抗凝药与RAO风险之间的关系。方法招募了377例行经patients动脉导管插入术的患者。在去除鞘之前测量活化的凝结时间（ACT）。根据ACT值将患者分为3组（ACT <150 s，ACT在150至249 s之间，ACT> 250 s），所有患者均尝试采用反向Barbeau试验进行专利止血，并尽快移除加压装置。在24小时内，使用反向Barbeau技术通过多普勒检查radial动脉的通畅性。结果对于极端ACT值，RAO的发生率更高。对于增加的ACT值，获得专利性止血的频率较低，并且止血时间明显更长（趋势的P = 0.004，趋势的P <0.0001）。在逻辑回归分析中，<150 s的ACT值是RAO的独立预测因子（赔率，3.53； 95％IC，1.677-7.43； P = 0.001），而调整后的RAO概率证实了与ACT值呈U形关系。结论抗凝水平与RAO的发生密切相关，应通过ACT客观测定。临床试验注册网址：https://www.clinicaltrials.gov。唯一标识符：NCT02762344。