Low Molecular Weight Heparin With Anti-platelet Therapy For Protection Of Radial Artery In Transradial Coronary Artery Angiography

Objective:To investigate the effect of Low molecular weight heparin with dual antiplatelet therapy on prevention of radial artery occlusion and protection of radial artery in patients receiving the transradial row coronary artery angiography.Methods:Among patients who underwent transradial coronary artery angiography（TRA）in our hospital from 2021/06/01 to 2022/03/31,a total of 438 patients were enrolled according to inclusion and exclusion criteria.Patients were divided into three groups according to their postoperative drug regimen : blank group,dual antiplatelet therapy group,and low molecular weight heparin + dual antiplatelet therapy group.Radial artery occlusion was defined as loss of antegrade blood flow signal on radial artery ultrasound.To compare differences in baseline data such as gender、age、diabetes mellitus、hypertension、smoking history、age、creatinine、urea nitrogen、uric acid、 low-density lipoprotein and sheath diameter/radial artery diameter among the three groups.The incidences of radial artery occlusion on the postoperative 7^th day were compared among the three groups.Preoperative and postoperative radial artery ultrasound parameters were compared among the three groups too,including peak systolic flow velocity（PSV）,peak diastolic flow velocity（EDV）,resistance index（RI）,intima-media thickness,and internal diameter.Results:There were no statistical differences in baseline data such as gender、age、diabetes mellitus、hypertension、smoking history、age、creatinine、urea nitrogen、uric acid、 low-density lipoprotein and sheath diameter /radial artery diameter among the three groups.After TRA,the incidences of radial artery occlusion were 8.1% in the blank group、 2.2% in the dual antiplatelet therapy group and 2.9% in the low molecular weight heparin + dual antiplatelet therapy group respectively.Moreover,there was a statistical difference（P = 0.031 < 0.05）.Among them,there was no statistical difference between the dual anti-platelet therapy group and the low molecular weight heparin + dual anti-platelet therapy group by a two-by-two comparison（P = 0.659 > 0.0125）.There was no statistical difference in the preoperative indexes of the right radial artery ultrasound among the three groups and no statistical difference between the preoperative indexes and postoperative indexes of the left radial artery ultrasound.There were statistical differences in three data of radial artery resistance index（P = 0.016 < 0.05）、intima-media thickness（P = 0.001 < 0.05）and radial artery internal diameter（P < 0.001）among the three groups.However,the resistance index,intima-media thickness,and radial artery internal diameter in the low molecular weight heparin+dual anti-platelet aggregation group were not statistically different from that in the dual anti-platelet aggregation group.In particular,there were statistically significant differences in the radial artery resistance index,intima-media thickness,and radial artery internal diameter between the postoperative blank group and the duplex antiplatelet aggregation group.Conclusion:1.The dual antiplatelet therapy after TRA has a beneficial effect on preventing the occurrence of postoperative RAO and protecting the radial artery.2.Addition of low molecular weight heparin to the dual antiplatelet therapy after TRA had no significant effect on prevention of postoperative RAO occurrence and protection of the radial artery.3.The use of dual antiplatelet therapy or low molecular weight heparin + dual antiplatelet therapy for 7 consecutive days after TRA did not increase the incidence of bleeding events.