Study On The Hemostatic Effect Of Chitosan Hemostatic Sponge After Transradial Coronary Intervention

Objective:To investigate the clinical use of three different compression hemostasis methods after coronary interventions via the radial route regarding vascular complications at the puncture site and patient comfort.To evaluate the effectiveness,safety,and superiority of chitosan hemostatic sponges for hemostasis after transradial coronary interventions,and to provide a theoretical basis and reference for the selection of hemostatic methods after future coronary interventions.Method:The study prospectively included 295 patients who underwent coronary angiography or coronary intervention via the radial route at the Department of Cardiovascular Medicine,Jiangxi Provincial People’s Hospital from April 2021 to July 2022 as study subjects.The following three groups were randomly split using a random number table: spiral radial artery compression device group(group A,n=99),chitosan hemostatic sponge group(group B,n=98)and chitosan hemostatic sponge combined with spiral radial artery compression device group(group C,n=98).Clinical baseline data and surgery-related information were collected and collated from all enrolled patients.We observed and recorded the incidence of postoperative vascular complications at the puncture site such as bleeding,ecchymosis,blistering,skin breakdown,limb swelling,hematoma,numbness,cyanosis,and radial artery occlusion in the three groups,and the comfort score was based on the patient’s postoperative sensation of pressure hemostasis.To examine and contrast the incidence of vascular complications at the puncture site and the level of patient comfort following pressure hemostasis in the three groups.Observations with statistical differences were compared in pairs.All data were statistically analyzed using IBM SPSS 26.0 software,and P values or adjusted P values <0.05 were considered statistically significant differences,and post hoc two-by-two comparisons were made using the Bonferroni method corrected for test level(α),and P values<0.017 were considered statistically significant.Results:This study includes 295 individuals who received radial coronary intervention or coronary angiography in total.All patients’ average ages were(61.97±11.08)years,and 63.4% were male.The baseline clinical data of the three groups did not differ statistically significantly(P>0.05).After using different compression hemostatic devices in the 3 groups,there was a statistically significant difference in the incidence of postoperative bleeding,ecchymosis and swelling of the extremity on the puncture side compared(P<0.05),whereas there was no statistically significant difference in the incidence of postoperative blistering,skin breakdown,numbness,cyanosis and radial artery occlusion on the puncture side compared(P>0.05).After further two-by-two comparison,in terms of the incidence of bleeding,the incidence of bleeding after compression hemostasis was significantly higher in group A than in group C(13.1% vs.3.1%,P=0.010),and there was no difference in group B compared with groups A and C(5.1% vs.13.1%,P=0.051;5.1% vs.3.1%,P=0.718);In terms of the incidence of ecchymosis,there was a difference in the incidence of ecchymosis after compression hemostasis in group A compared with group C(22.1%vs 6.1%,P=0.001),and no difference in group B compared with groups A and C(11.2% vs 22.2%,P>0.017;11.2% vs 6.1%,P=0.204);In terms of the incidence of limb swelling,the incidence of postoperative limb swelling was significantly higher in group A than in group C(15.2% vs.4.1%,P=0.008),and there was no difference in group B compared with groups A and C(9.2% vs.15.2%,P=0.200;9.2% vs.4.1%,P=0.151).These results suggest that the incidence of postoperative hemorrhage,ecchymosis and limb swelling after the use of chitosan hemostatic sponge and spiral radial artery compressors is significantly lower than that of spiral radial artery compressors alone.For comparison of forearm hematoma,the incidence of forearm hematoma grade I and II after compression hemostasis was significantly higher in group A than in group C(adjusted P value <0.05),and no severe grade III or IV hematoma was found in any of the three groups.In terms of postoperative patient comfort evaluation,group C was significantly better than group A in terms of patient comfort evaluation after compression hemostasis in the three groups(adjusted P value <0.05).These results mention that the incidence of forearm hematoma after compression hemostasis with chitosan hemostatic sponge + spiral radial artery compressor was significantly lower than with the spiral radial artery compressor alone,and patient comfort was rated higher.Conclusion:The hemostatic effect of chitosan hemostatic sponge combined with spiral radial artery compressor after coronary angiography or coronary intervention via radial artery route is better than that of spiral radial artery compressor alone,with lower incidence of postoperative bleeding,ecchymosis,limb swelling and forearm hematoma,and higher patient comfort rating,which is a safe and effective postoperative hemostatic modality with easy operation,high patient satisfaction,and few vascular complications.