Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or above

J Vasc Interv Radiol. 2018 Mar;29(3):383-388. doi: 10.1016/j.jvir.2017.11.010. Epub 2018 Feb 1.


Purpose: To examine the safety and outcomes for patients undergoing transradial noncoronary interventions with international normalized ratio (INR) ≥1.5.

Materials and methods: A retrospective review of 2,271 transradial access (TRA) cases performed from July 2012 to July 2016 was conducted. Criteria for inclusion were moderate bleeding risk cases with preprocedure INR ≥1.5. Within the study period, there were 176 moderate bleeding risk procedures (transarterial chemoembolization: 70/176 [39.8%]; Barbeau B: 121/176 [68.8%]; 5-F sheath: 157/176 [89.2%]) performed on 122 patients (age 61.6 ± 12.1 years, 68.9% male, body mass index 28.0 kg/m2) with INR ≥1.5.

Results: Technical success was achieved in 98.9% of cases. Grade 1/2 hematomas developed in 10 cases (5.7%). Age ≥65 years (P = .042) and female sex (P = .046) were predictive of access site bleeding complications. Fresh frozen plasma (FFP) transfusion was administered in 11.4% of cases (n = 20). Baseline INR and creatinine were significantly different between transfused and nontransfused cases (P values .006 and .028, respectively). Minor access site bleeding occurred in 3/20 cases (15%) receiving prior FFP transfusion and 7/156 nontransfused cases (4.5%), with no significant difference between these 2 groups (P = .072).

Conclusions: TRA in patients with elevated INR appears to be safe in our experience. Age ≥65 years and female sex were associated with increased incidence of access site bleeding. Although INR correction was not standardized in this cohort, preprocedure FFP transfusion did not decrease bleeding complications.

MeSH terms

  • Blood Component Transfusion
  • Catheterization, Peripheral / adverse effects*
  • Female
  • Hemorrhage / etiology*
  • Hemorrhage / therapy*
  • Humans
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Radial Artery / surgery*
  • Radiography, Interventional
  • Retrospective Studies
  • Treatment Outcome