Assessment of Radial Artery Complications Whilst Achieving Rapid Haemostasis

Not Applicable

Terminated

• Conditions: Injury; Blood Vessel, Wrist, Radial Artery
• Interventions: Device: Conventional Dressing; Device: Haemostatic Dressing; Device: 60 Minutes External Compression; Device: 120 Minutes External Compression

• Registration Number: NCT04457219
• Lead Sponsor: Liverpool Heart and Chest Hospital NHS Foundation Trust

Brief Summary

The purpose of this study is to compare different protocols aimed at achieving haemostasis (i.e. stop the bleeding) in patients undergoing heart procedures with access through the wrist. Specifically, a haemostatic dressing that aids clotting at the level of the skin will be used and compared with a normal absorbent dressing. Also, a shorter time of compression required to stop the bleeding at the access site will be evaluated.

Detailed Description

Radial access for percutaneous cardiac procedures is the preferred method used by most interventional cardiologists. This method has proven to have the least complications and a much quicker patient's recovery time, compared to other access sites (e.g. femoral or brachial). Following sheath removal, a dressing is applied on the skin at the access site. Dressing currently in use include:

1. Conventional absorbent - an absorbent sterile adhesive dressing. This is our current, standard care.

2. Haemostatic - a sterile mineral-based absorbent dressing that aids clotting. It is not currently used at Liverpool Heart and Chest Hospital (LHCH), but it is a licenced product.

A radial compression device is placed over the dressing, and it applies the appropriate amount of mechanical pressure to guarantee patent haemostasis.

This study will recruit patients who are undergoing a cardiac procedure with intended radial access, as part of their standard care. The aim of this study to look at new techniques to reduce the time to successful and complete haemostasis. This may help to expedite patient discharge (avoiding unplanned overnight stay), to reduce nursing times and to decrease the rate of post-procedural, access site-related bleeding and ischemic complications.

At the end of the cardiac procedure, participants will be randomised in a 1:1:1 ratio to one of the following 3 arms:

Arm 1 - conventional absorbent dressing and a compression device applied for 60 mins; Arm 2 - conventional absorbent dressing with a compression device applied for 120 mins (the current standard practice at LHCH); Arm 3 - haemostatic dressing and a compression device applied for 60 mins.

This is a low-interventional, low-risk, pragmatic study comparing strategies that are currently used in every-day clinical practice. The consent seeking process is proportionate and adapted to the design of the study.

Data collection will be electronic and will be performed by medical and nursing staff as part of their normal clinical practice. This will obviate the use of paper-based case record forms.

This study will actively involve medical and nursing staff across the hospital, facilitating multidisciplinary collaboration and integration of clinical research with everyday clinical practice.

Study Timeline

• Study First Submitted: 2020-06-15
• Study Start: 2020-06-18
• Study First Submitted QC: 2020-06-30
• Study First Posted: 2020-07-07
• Primary Completion: 2022-01-28
• Study Completion: 2022-01-28
• Status Verified: 2022-04
• Last Update Submitted: 2022-04-06
• Last Update Posted: 2022-04-14

Recruitment & Eligibility

• Status: TERMINATED
• Sex: All
• Target Recruitment: 2114

Inclusion Criteria

Not provided

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Exclusion Criteria

• < 18 years of age
• Planned bilateral radial access
• Any haematoma (> 5 cm in its longest dimension) at planned puncture site prior to radial sheath insertion
• Established diagnosis of any haematologic disorder or genetic defect predisposing to bleeding
• Patients with International Normalised Ratio (INR) > 2.5 prior to the scheduled angiographic procedure
• Inability to perform adequate consent: communication issues (e.g. mental capacity); inadequate time for the participant to read and consider trial; unscheduled Urgent or Emergency procedures i.e. PPCI
• Patients who are scheduled to be transferred to other hospitals ("treat and return") before haemostasis is achieved.
• Electronic Patient Record technical failure leading to an inability to record participants' care

In-Cath Lab Inclusion Criterion:

Single radial sheath in situ with planned removal in lab

In-Cath Lab Exclusion Criteria:

• Sheath removal after 17:00 hrs
• Patient leaving lab with radial sheath in situ
• Trans-ulnar procedure
• Distal (snuffbox) trans-radial procedure
• Any puncture-related haematoma (> 5cm in its longest dimension) prior to radial sheath removal
• Randomisation system not available
• Dressings of both types not available
• A change in patient's clinical condition during procedure deemed by the operator sufficient to exclude from the trial
• Procedural complication requiring procedure termination

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Conventional dressing with 60 minutes external compression	60 Minutes External Compression	A standard absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 1 hour, as per protocol.
Conventional dressing with 120 minutes external compression	120 Minutes External Compression	A standard absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 2 hours, as per protocol. This is the standard radial care currently in use at Liverpool Heart and Chest Hospital.
Conventional dressing with 60 minutes external compression	Conventional Dressing	A standard absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 1 hour, as per protocol.
Conventional dressing with 120 minutes external compression	Conventional Dressing	A standard absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 2 hours, as per protocol. This is the standard radial care currently in use at Liverpool Heart and Chest Hospital.
Haemostatic dressing with 60 minutes external compression	60 Minutes External Compression	A haemostatic absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. This consists of a mineral-based dressing that accelerates local haemostasis. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 1 hour, as per protocol.
Haemostatic dressing with 60 minutes external compression	Haemostatic Dressing	A haemostatic absorbent dressing is placed on the radial access site, following the transradial angiographic procedure. This consists of a mineral-based dressing that accelerates local haemostasis. A radial compression device is then applied to secure patent haemostasis, once the radial sheath is removed. The compression device remains in place for a minimum of 1 hour, as per protocol.

Primary Outcome Measures

Name	Time	Method
The rate of failure to achieve haemostasis at the planned compression time	Estimated average of 90 minutes	After radial sheath is removed and initial haemostasis is secured by Cath Lab team, new overt bleeding or puncture-related haematoma development, occurring out of the Cath Lab, during planned compression period such that: * an additional compression device or pressure dressing is applied OR; * the radial dressing and compression device (either original device or new device) are re-applied de novo OR; * planned compression duration period to be restarted; OR; At the time of planned compression device removal, perceived failure of puncture site haemostasis, manifest as overt bleeding or puncture-related haematoma, that requires re-application of compression (either with the original device, a new device, an additional device, manual compression or a pressure dressing)

Secondary Outcome Measures

Name	Time	Method
Rate of bleeding complications	From randomisation until discharge from hospital, estimated average of 8 hours	Incidence of bleeding complications related to the arterial puncture. The bleeding complications that will count as secondary outcome measure for the trial will be: * Puncture-related haematoma (grades II, III and IV); * Vascular surgical or percutaneous intervention for arterial injury or bleeding
Incidence of post-procedural radial artery occlusion	From randomisation until discharge from hospital, estimated average of 8 hours	Incidence of radial artery occlusion, as a series of parallel, paired comparisons, between the randomised arms of the trial
Incidence of patients with delayed discharge due to the need for radial access site care	Estimated average 12 hours	The number and proportion of patients experiencing delayed discharge for reasons related to haemostasis. An analysis plan, including detail of cost-effectiveness model surrounding this outcome, will be produced at a later stage.
Time to Haemostasis	From randomisation until discharge from hospital, estimated average of 8 hours	Time to haemostasis is the interval of time between initial haemostasis following sheath removal and all compression removed, without any compromise in final haemostasis. This outcome measure will report the 'reality' of the time to haemostasis rather than the target period.

Trial Locations

Locations (1)

Liverpool Heart & Chest Hospital; 🇬🇧 Liverpool, Merseyside, United Kingdom