524 SAFETY OF HAND-HELD ULTRASOUND GUIDANCE FOR JUGULAR RIGHT HEART CATHETERIZATION IN ANTICOAGULATED PATIENTS: A TERTIARY CARE CENTER RETROSPECTIVE STUDY
Authors: Arata Allegra , Venza Saverio , Giuliani Livio , Rossi Serena , Ricci Fabrizio , Gallina Sabina 
Published: December 2022

Abstract

Background
RHC is currently the gold standard in the assessment of diagnosis, prognostic evaluation, and decision-making of pulmonary hypertension patients. Internal jugular vein (IJV) access is the preferred option among the available vascular access routes in most of pulmonary hypertension centers; furthermore, ultrasound (US) guidance is strongly recommended for the IJV access (IA) since it reduces the number of access complications. Many patients requiring RHC are on long-term oral anticoagulant therapy. Continuation of direct oral anticoagulant (DOAC) has been shown to be safe in patients undergoing percutaneous coronary intervention (PCI) and cardiac implantable electronic device implantation (CIED). However only few data in the literature are available in the setting of RHC.

Objectives
To compare the feasibility and safety of ultrasound (US)-guided IJV access for RHC procedure in pulmonary hypertension's patients anticoagulated vs non-anticoagulated.

Methods
This is a retrospective observational single–center study, including a cohort of 114 consecutive patients undergoing RHC via IJV assess by US guidance RHC at our tertiary care center between February 2018 and February 2022. The primary outcome was a composite of general (defined as overall success rate, patient discomfort, syncope, mortality) and access site complications (defined as significant hematoma formation greater than 5 cm in diameter, thrombosis, embolism, arterial puncture, pneumothorax, haemotomediastinum and hydro mediastinum, subcutaneous emphysema and nerve injury) after adequate hemostasis, at the access site at 6-hour post procedure.

Results
Of the 114 patients, 50 (44%) were on anticoagulation and 64 (56%) were not. Mean age was 71 ± 13 and 59 ± 16 years, respectively. The main indication for anticoagulation was atrial fibrillation in 40 (80%) patients. 43 (86%) patients were on DOAC, only 7 (14%) on Warfarin. 13 patients were on single antiplatelet therapy and 8 were on double antiplatelet therapy. Mean INR value was 1.25 ± 0.33 in the anticoagulated population and 1.08 ± 0.11 in the non-anticoagulated one. HAS-BLED score was equal or greater than 3 in 29 (25%) patients. Indication for RHC was mainly confirmation of PH class I diagnosis (54% of patients). None of the patients enrolled developed general or access site complications, except for 1 (2%) non-anticoagulated patient who develop a significant hematoma (defined as &gt;5 cm in diameter) at the puncture site. All patients underwent day-hospital regimen, were able to mobilize immediately following the procedure, and were discharged as planned at 6 hours.

Conclusions
To the best of our knowledge this is the first study in the literature supporting the feasibility and safety of US guided IJV approach to RHC in anticoagulated patients when compared to non-anticoagulated patients affected by pulmonary hypertension.
Keywords: Right heart catheterization, catheterization, anticoagulation, internal jugular vein, US-guidance, access site complications