Meta-analysis Of The Efficacy And Safety Of Defferent Doses Of Heparin In Preventing Radial Artery Occlusion After Transradial Coronary Angiography

Objective:To comprehensively analyze the safety and efficacy of high dose heparin and low dose heparin in preventing postoperative incidence of radial artery occlusion in patients undergoing coronary angiography via radial artery route by Meta analysis.Methods:a randomized controlled trial(RCTs)on the relationship between the dose of unfractionaled heparin used in coronary angiography and postoperative radial artery occlusion rate was performed from the self-established database to December 2018 by using computer to retrieve PubMed,Embase,Cochrane,CNKI,wanfang database,VIP database and other electronic databases.The Revman5.3 software was used for to observe the effect of high-does and low-dose unfractionaled heparin on the prevention of postoperative adverse events(redial artery occlusion)and safety-related outcomes(hemorrhage and hematoma formation).The OR value(the combined effect size)and its corresponding 95 confidence interval(95%CI)were calculated.Results:A total of 7 RCTs were included,with a total of 4503 cases in the case groups and the control groups.Compared with the low dose heparin group,the incidence of postoperative radial artery occlusion in the high-dose heparin group was lower,indicating that the high dose heparin could prevent the occurrence of radial artery occlusion more effectively,and the combined effect volume was statistically significant,but there was also greater heterogeneity(combined OR=0.42,95%CI:0.24-0.74,I~2=77%,Z=3.00,P=0.003).Multiple subgroup analyses were performed on the basis of race,follow-up time and sheath model,respectively.The subgroup analysis indicated that racial difference was one of the sources of heterogeneity in this study,iand the difference in the incidence of radial artery occlusion between the high-dose heparin group and the low-dose heparin group in the European population was statistically significant(merger OR a value of 0.52,95%CI:0.40-0.67,I~2=49%,Z=4.93,P<0.00001).There were statistically significanpt differences in the incidence of radial artery occlusion between the high dose heparin group and the low dose heparin group in Asian populations(P<0.00001).The length of follow-up was not the source of heterogeneity(the duration of follow-up was more than 30 days:I~2=73%,OR=0.48,95%CI:0.12-1.87,Z=1.06,P=0.29>0.05,less than 30 days:I~2=82%,combined OR=0.38,95%CI:0.18-0.79,Z=2.60,P=0.009.Differences in sheath size are also not a source of heterogeneity:(I~2=91%,OR=0.36,95%CI:0.09-1.36,Z=1.51,P=0.13>0.05 In the 5F sheath tube group,I2=87%,combined OR=0.39,95%CI:0.14-1.06,Z=1.84,P=0.07>0.05,not statistically significant,when in the 6F sheath tube group,I~2=71%,combinedOR=0.48,95%CI:0.12-1.98,Z=1.01,P=0.31>0.05.The incidence of haemorrhage and hematoma between the high dose heparin group and the low dose heparin group in the general population was not statistically significant(combined OR=1.78,95%CI:0.89-3.55,Z=1.63,P=0.10>0.05,not statistically significant).Conclusion:the high dose heparin in coronary angiography can better prevent postoperative radial artery occlusion than the low does,and at the same time the risk of bleeding or hematoma will not be increased.