Timing of Anticoagulant Administration During Radial Access Percutaneous Coronary Intervention: the HERA-PCI Study (Heparin Early for Radial Access Percutaneous Coronary Intervention)

Prevention of radial occlusion relies on optimal hemostasis and anticoagulation. Previous studies have demonstrated a decrease incidence of radial artery occlusion through hemostasis at the puncture site using short-duration mechanical compression methods, guided by mean arterial pressure measurement, or clinical tests evaluating hand vascularization. Anticoagulation plays a central role in the prevention of radial occlusion. It is currently recommended to administer a systemic anticoagulant during a procedure using radial access. Despite the lack of consensus on the nature of the anticoagulant, an international survey showed that more than 90% of interventional cardiologists use unfractionated heparin. The intensity of anticoagulation is also associated with the risk of radial artery occlusion, with previous studies showing that the risk is reduced with the use of "high doses" (5000 IU or 75 IU/kg) compared to "low doses" (<5000 IU or <50 IU/kg). A randomized controlled trial did not show any difference between intravenous and intra-arterial heparin injection via the sheath. No studies have examined the timing of anticoagulant administration relative to sheath insertion. In current practice, anticoagulant administration is typically done after sheath insertion in the radial artery. This common practice likely stems from historical concerns about conversion to femoral access (which is now rare due to improved devices for radial puncture and less consequential due to vascular closure systems used in femoral access, significantly reducing hemorrhagic risk).

No data is currently available on the optimal timing of anticoagulant administration, despite the potential modification of its local effect if the sheath is already in place in the radial artery during the anticoagulant injection, obstructing the radial artery lumen. Our hypothesis is that intravenous anticoagulant administration before sheath insertion in the radial artery is more effective than administration after sheath insertion in patients undergoing percutaneous coronary intervention via radial access. The expected outcomes include a reduction in the incidence of radial artery occlusion after the procedure, leading to a decrease in potential complications (acute hand ischemia, failure of the access route during a subsequent procedure, inability to create an ipsilateral arteriovenous fistula).

The primary objective is to evaluate the impact of the timing (early or late) of intravenous anticoagulant administration on the risk of radial occlusion during a percutaneous coronary intervention via radial access.

This is a single-center, comparative, randomized, single-blind study with blinded evaluation of the primary endpoint.

After providing information and verifying eligibility criteria, the investigator will obtain the patient's free, informed, and written consent before any intervention, on the day the coronary angiography is scheduled. Consent will be obtained in the patient's hospital room (Cardiology Day Hospital or conventional hospitalization unit).