Enoxaparin for Preventing the Radical Artery Occlusion After the Transradial Access Hepatic Arterial Infusion Chemotherapy: A Multicenter, Randomized Controlled Trial.

Primary liver cancer ranks sixth globally in incidence and fourth in mortality, with over 800,000 new cases annually . Hepatocellular carcinoma (HCC) accounts for over 80% of primary liver cancers. Due to its insidious onset, most patients present with intermediate to advanced stage disease at diagnosis and are ineligible for curative treatments such as surgical resection or liver transplantation. For unresectable liver cancer, a combination of locoregional therapies (e.g., transarterial chemoembolization, hepatic arterial infusion chemotherapy) and systemic treatments (e.g., targeted therapy, immunotherapy) constitute the standard care.

Hepatic Arterial Infusion Chemotherapy (HAIC) delivers high concentrations of chemotherapy agents directly to the tumor via the hepatic artery, leading to more effective tumor cell kill and suppression. Recent advances in HAIC using the FOLFOX regimen (oxaliplatin, fluorouracil) for intermediate and advanced HCC have been made by researchers in China . However, HAIC typically requires long infusion times. Traditional HAIC involves arterial sheath and catheter placement via the femoral artery, necessitating bed rest for 24-48 hours post-operation, reducing patient comfort, and increasing the risk of deep vein thrombosis in the lower limbs due to prolonged immobilization . Recently, the transradial approach for peripheral intervention has gained attention. Transradial HAIC is favored in clinical practice as it does not require postoperative immobilization or carry the risk of causing deep vein thrombosis in the lower limbs.

Radial artery occlusion (RAO) is the most common complication following transradial interventions, often asymptomatic and diagnosed via radial artery ultrasound. The incidence of RAO post-transradial coronary interventions is reported to be between less than 1% to 33% . Preventive measures for RAO typically include: using catheters of the appropriate size (sheath diameter should be less than the radial artery lumen); intraoperative use of unfractionated heparin, short-term postoperative oral anticoagulation; patent hemostasis and shorter compression times . Transradial HAIC is a relatively new practice with limited research. A recent domestic study indicated that the incidence of RAO following transradial FOLFOX-HAIC was as high as 35%, potentially related to prolonged sheath placement and multiple procedures. Retrospective and prospective analyses suggest that the use of low molecular weight heparin during infusion may reduce the incidence of RAO postoperatively . While prophylactic anticoagulation is standard for patients at high risk of venous thromboembolism, it is not typically administered to low-risk patients. Hence, the potential of enoxaparin sodium for prophylactic anticoagulation during transradial HAIC to reduce RAO incidence warrants further investigation.

RAO can preclude the possibility of future transradial interventions, impacting the patient's options for intervention access and treatment strategy. Thus, preventing RAO following transradial HAIC has significant clinical importance. This study aims to explore the efficacy of prophylactic enoxaparin sodium in preventing postoperative RAO through a randomized controlled trial.

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