Forearm hematoma is a recognized complication after transradial coronary interventions (TRI). Though generally manageable, its occurrence can lead to discomfort and longer recovery times. This case study aims to assess the incidence and predictors of forearm hematoma formation in an Indian cohort undergoing TRI.
Study Overview
This prospective study was conducted at a single center and involved 1,754 patients undergoing either coronary angiography or angioplasty through the transradial approach. Standard protocols were followed, including the use of hydrophilic sheaths, optimal anticoagulation, and post-procedure patent hemostasis. Hematoma formation was assessed immediately after the procedure, following radial band removal, and on the next day. The severity of hematomas was classified according to the Early Discharge after Transradial Stenting of Coronary Arteries Study (EASY) scale.
Methods
Patients were monitored for the development of forearm hematomas across various time points. Univariate and multivariate logistic regression analyses were used to identify predictors of hematoma formation. Factors such as gender, number of puncture attempts, the complexity of the procedure, antiplatelet therapy, and hemostasis duration were evaluated.
Results
- Patient Demographics: The average age of patients was 56.31 years, and 82.2% of the participants were male.
- Procedures: Of the total patients, 1,374 (78.3%) underwent angioplasty, while 380 (21.7%) underwent angiography.
- Hematoma Incidence: Forearm hematoma was observed in 187 patients, accounting for 10.7% of the study population. The breakdown of hematoma severity was:
- Grade I: 3.53%
- Grade II: 3.08%
- Grade III: 2.83%
- Grade IV: 1.25%
- Severity: Despite the occurrence of hematomas, none of the patients required vascular or surgical intervention.
Significant Predictors of Hematoma Formation:
- Female Gender: Women were more prone to developing hematomas post-TRI.
- Multiple Puncture Attempts: Difficulty in accessing the radial artery was linked to a higher risk of hematoma.
- Intensive Antiplatelet Therapy: Patients receiving stronger antiplatelet treatment were more likely to experience bleeding complications.
- Complex Procedures: More complicated interventions increased the likelihood of hematoma formation.
- Longer Hemostasis Time: Prolonged compression post-procedure was associated with a higher risk of hematomas.
Conclusion
Forearm hematomas developed in a notable proportion of patients (10.7%) undergoing transradial coronary interventions. Most cases were mild (Grade I and II), but modifiable procedural factors, such as limiting the number of puncture attempts and reducing hemostasis time, may help in preventing hematoma formation. Preemptive knowledge of these risk factors can help interventional cardiologists reduce the incidence and severity of this complication, ultimately improving patient outcomes.