From the Guidelines
The recommended approach to minimize bleeding complications after arteriopuncture in patients with coagulopathy or those who have received thrombolytic therapy is to use the radial artery approach as the default vascular access, as it has been shown to reduce the risk of bleeding complications compared to the femoral approach 1.
Key Considerations
- The radial approach is preferred due to its lower risk of bleeding complications, especially in patients at high risk of bleeding, such as those on anticoagulant and antiplatelet therapy 1.
- Manual pressure should be applied to the puncture site for at least 15-30 minutes, followed by a pressure dressing for 6-8 hours, with the duration extended for patients with more severe coagulopathies or those who have recently received thrombolytics.
- Regular assessment of the puncture site and distal pulses is essential during this period.
- If available, ultrasound-guided compression can be used to ensure pressure is applied directly over the arterial puncture site.
- For patients on anticoagulants, consider temporarily holding the next dose if clinically appropriate.
Minimizing Bleeding Complications
- The use of proton pump inhibitors (PPIs) should be considered to reduce the risk of gastrointestinal bleeding, particularly in patients on oral anticoagulant (OAC) therapy 1.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) should be limited due to their potential interference with the efficacy of aspirin and the associated increased risk of bleeding and thrombotic complications 1.
- Managing bleeding complications involves controlling the bleeding, diagnosing and treating the underlying cause, and minimizing the duration of interruption of antithrombotic therapy to reduce the risk of thromboembolic complications during antithrombotic treatment interruption 1.
From the Research
Arteriopuncture Considerations
- Arteriopuncture must be avoided in all patients with INR greater than 2.0 is not entirely accurate, as the decision to perform arteriopuncture depends on various factors, including the patient's overall condition and the urgency of the procedure 2.
- In patients with coagulopathy, arteriopuncture is best performed on the radial artery, as it is associated with lower complication rates compared to other sites, such as the brachial artery 3.
- Numerous studies have not established the safety of arteriopuncture in patients who have received thrombolytic therapy, and caution is advised when performing arteriopuncture in these patients 3.
- Extended post-procedure compression should be used in patients who have undergone arteriopuncture to minimize bleeding complications, and the use of hemostatic devices can help reduce compression time 4.
Coagulopathy Management
- Early recognition of coagulopathy is necessary for its prompt correction and successful management, and novel approaches such as point-of-care testing and administration of coagulation factor concentrates can help tailor haemostatic therapy to each patient 5.
- In case of major bleeding or urgent surgery in patients treated with vitamin K antagonist anticoagulants, prothrombin complex concentrate can effectively reverse the effects of the anticoagulant drug 5.
Thrombolytic Therapy
- Thrombolytic therapy can be effective in the treatment of thrombosis due to radial artery cannulation, and percutaneous catheter-directed thrombolytic infusion appears to be effective in the treatment of most patients with severe ischemic hand symptoms due to thrombosis after radial artery cannulation 3.
Antithrombotic Therapy
- Antithrombotic therapy for coronary artery disease involves the use of aspirin, clopidogrel, and other agents to reduce the risk of thrombotic events, and the choice of therapy depends on the patient's individual risk factors and clinical presentation 2.