Conventional versus facilitated hemostatic dressings after radial artery puncture: a systematic review and meta-analysis
Authors: Kulyassa P , Engh M A , Kneller E , Toth C , Fehervari P , Hegyi P , Merkely B , Edes I F 
Published: November 2023

Abstract
In the last thirty years, transradial access (TRA) became the gold standard access site for minimal invasive coronary diagnostics and therapy. Though the complication rate is relatively low, TRA is frequently iterated, therefore the slightest improvement could be utmost beneficial for a big proportion of cardiology patients. In recent few years, facilitated hemostatic dressings with the utilisation of chitosan and potassium ferrate molecules were introduced into the clinical practice to improve postprocedural hemostasis. The available evidence suggests that the novel dressings are decreasing complication numbers, but currently no coherent meta-analysis is available on the subject.
We hypothesised that better clinical outcomes can be expected with the novel facilitated hemostatic dressings in terms of radial artery occlusion, radial artery damage, time to hemostasis and hematoma events compared to conventional mechanical compression devices.
A systematic search was performed in Medline, Central Web of Science, Scopus and Embase on 13th January, 2023. Randomised controlled trials comparing chitosan and potassium-ferrate covered dressings to pneumatic or screwable mechanical compression devices. Observational studies, trials not reporting outcomes or containing scientifically unproven devices were excluded. The RoB 2 tool was used for risk of bias assessment, which was low across the included studies. As primary endpoint, radial artery occlusion (RAO) was determined, the secondary endpoints were hematoma events, time to hemostasis and radial artery damage (dissection, pseudoaneurysm). Raw data from the selected studies were pooled using a random effects model with the Mantel-Haenszel method and the Hartung-Knapp adjustment. Statistical heterogeneity across trials was assessed by means of Cochrane Q test, and the I2 values.
Data of a total of 3524 patients were collected from 7 randomised controlled trials. Concerning the primary endpoint, RAO, a 0.70 relative risk (RR) was found (p=0.028, confidence interval (CI): 0.52-0.95) in favour of the facilitated hemostatic devices. In the chitosan subgroup a lower tendency of RAO in the facilitated group (RR: 0.66 p=0.059 CI: 0.42-1.03) was found. In the potassium ferrate subgroup no significant difference was observed between the devices (RR: 0.93 p=0.819 CI: 0.27-3.20). Low grade (EASY I/II) hematoma events were not significantly different between the two examined groups (RR: 0.76 p=0.268 CI: 0.43-1.32). Time to hemostasis was 95.8 (mean difference, p≺0.001 CI: 46.8-144.9) minutes shorter in the facilitated devices group from 5 studies containing 2132 patient’s data. This meta-analysis includes the largest number of patients for facilitated hemostatic dressings to date. These devices lower the incidence of RAO by 30% compared to mechanical compression devices with the additional advantage of reduced compression times. More randomised controlled clinical trials are needed in the subject.