Frequency of radial artery occlusion after transradial access in patients receiving warfarin therapy and undergoing coronary angiography

Am J Cardiol. 2014 Jan 15;113(2):211-4. doi: 10.1016/j.amjcard.2013.09.043. Epub 2013 Oct 5.


The efficacy of warfarin-induced anticoagulation in reducing radial artery occlusion (RAO) after transradial access is not known. The present case-control study compared the incidence of early (24 hours) and late (30 days) RAO in patients undergoing transradial diagnostic coronary angiography during therapeutic warfarin anticoagulation (group 1) with that of a matched (3:1) cohort of patients not receiving warfarin and receiving intraprocedural heparin (group 2). All patients underwent transradial diagnostic coronary angiography using a 5F hydrophilic introducer sheath. The patients in group 2 received an intravenous heparin bolus (50 IU/kg) immediately after sheath insertion. After sheath removal, hemostasis was obtained using the TR-band (Terumo Interventional Systems, Terumo Medical, Tokyo, Japan) and a plethysmography-guided patent hemostasis technique. We included 86 patients receiving warfarin with an international normalized ratio of 2 to 4 in group 1 and 250 matched patients in group 2. No significant differences were present in the demographic and procedural variables between the 2 groups. Early RAO occurred in 18.6% of the patients in group 1 compared with 9.6% of patients in group 2 (p = 0.024). The incidence of late RAO remained significantly higher in group 1 compared with group 2 (13.9% vs 5.2%, p = 0.01). All patients with RAO remained asymptomatic. In conclusion, patients receiving chronic oral anticoagulation with warfarin and undergoing transradial coronary angiography without parenteral anticoagulation had a higher incidence of early and late RAO compared with patients receiving standard intravenous heparin therapy.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Arterial Occlusive Diseases / epidemiology*
  • Arterial Occlusive Diseases / etiology
  • Arterial Occlusive Diseases / prevention & control
  • Cardiac Catheterization / adverse effects*
  • Coronary Angiography / adverse effects*
  • Coronary Angiography / methods
  • Coronary Disease / diagnostic imaging*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Pennsylvania / epidemiology
  • Prognosis
  • Radial Artery*
  • Retrospective Studies
  • Risk Factors
  • Warfarin / therapeutic use*


  • Anticoagulants
  • Warfarin