Inclusion in this meta-analysis was restricted to studies that met all the following eligibility criteria: (1) randomized controlled trials only; (2) comparing compressions facilitated with hemostatic agents to compressions without hemostatic agents; (3) enrolling patients who underwent transradial procedures; and (4) reporting any outcome of interest.

We excluded studies (1) that did not meet the inclusion criteria; (2) that were observational; (3) with overlapping populations; (4) abstracts; and (5) that did not report the baseline characteristics of the population to be included in the meta-analysis.

We systematically searched PubMed, Embase, and Cochrane Central using the search strategy provided in the Supplementary Figure 1 . The controlled vocabulary was removed for the Cochrane search, and, for Embase, it was adapted using the query translator. Three authors (C.N., M.O., and D.F.) independently searched following the prespecified criteria and quality assessment. Conflicts were resolved by the senior author (G.M.).

Three authors (C.N., M.O., and D.F.) independently extracted the data following predefined search criteria and quality assessment. This meta-analysis was prospectively registered on PROSPERO on May 21, 2025, under protocol #CRD420251048131.

The endpoints evaluated were: (1) time to achieve hemostasis (TAH); (2) 24-hour radial artery occlusion (24-RAO); (3) failure to achieve hemostasis (FAH); and (4) hematoma occurrence.

FAH was defined as failure of the previously established compression protocol.

In each plot, we did a subgroup analysis dividing the studies according to the hemostatic agent compression method into those that performed manual compression with the hemostatic agent and those that performed mechanical compression with the hemostatic agent.

Manual compression was defined as any compression without a compression device. Mechanical compression was defined as any compression with a compression device (pneumatic or screwable).

The first sensitivity analysis only included studies that compared compressions with hemostatic agents to 120-minute protocol compressions without hemostatic agents.

The second sensitivity analysis only included studies that used patent hemostasis.

95% confidence intervals (CI) were used to compare intervention effects. For binary endpoints risk ratio (RR) with the Mantel-Haenszel Method was used to pool the effect size. The continuous outcome was analyzed using the mean difference (MD) and the Inverse Variance Method to pool the effect size. Statistical significance was defined as a p-value < 0.05. Heterogeneity was assessed with I² statistics and the Cochran Q test; p-values < 0.10 and I² > 25% were considered significant for heterogeneity. According to the Shapiro-Wilk Test, for outcomes with normally distributed effect sizes, we used the restricted maximum likelihood estimator for in-between study heterogeneity, and, for outcomes with non-normally distributed effect sizes, we used the Paule-Mandel estimator. All analyses were made with a random-effects model. RStudio version 4.4.2 was utilized for statistical analysis.

Several included studies (ARCH trial, Politi et al., Gorgulu et al., Fech et al., and Roberts et al. reported 2 intervention or control arms relevant to the analysis. To appropriately incorporate these data into the forest plots, we adhered to the methodological guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. Thus, data from the relevant arms were combined and analyzed as a single aggregated group.

However, Roberts et al. had 3 interventions of interest. Two of them were manual compressions with hemostatic agent, and 1 was mechanical compression with hemostatic agent. In this case, we followed another recommendation of the Cochrane Handbook and placed this study in each plot twice: “Roberts 1 2024” (for the manual compression interventions) and “Roberts 2 2024” (for the mechanical compression intervention). The control group was equally divided among them, as recommended.

We performed meta-regression analyses for all outcomes and assessed for any interaction with the following characteristics: prevalence of diabetes mellitus, age, male proportion, 6F-sheath proportion, and proportion of interventional coronary procedures.

Leave-one-out sensitivity analyses were performed for outcomes exhibiting heterogeneity to evaluate the stability and robustness of the pooled effect estimates.

We evaluated the risk of bias in randomized studies using version 2 of the Cochrane Risk of Bias tool (ROB-2).

Three independent authors (C.N., M.O., and D.F.) completed the risk of bias assessment. After discussing the reasons for the discrepancy, disagreements were resolved through consensus. Publication bias was investigated by the Egger Test and Funnel-plot analysis for outcomes that evaluated 10 or more studies.

The systematic search yielded 2,993 results. After removing duplicate records and ineligible studies by title/abstract, 27 remained and were fully reviewed based on the inclusion criteria. Of these, a total of 13 randomized controlled trials were included, ^,,,,,,,,,,,, comprising 6,588 patients ( Figure 1 ). 2,924 (44.4%) patients underwent compression with hemostatic agents, and 3,664 (55.6%) underwent compression without hemostatic agents.

PRISMA flow diagram of study screening and selection.

Baseline characteristics of the included studies are reported in Table 1 . Six studies assessed radial compression with patent hemostasis (Pathan et al., Roberts et al., Gorgulu et al., ARCH trial, Haq et al., and PROTHECT trial). The studies that evaluated RAO verified it with either an ultrasound or the reverse Barbeau’s test. Only the STAT 2 trial performed ulnar compression concomitant to the radial compression.

Most of the included studies used a minimum heparin dose of 50 IU/Kg or 5000 IU. Fech et al. used a minimum of 30 IU/Kg, but it only included diagnostic procedures. The STAT 2 trial had a proportion of 59% who received at least 5000 IU. Pathan et al. did not specify a minimum but had an average of 6189.7 IU ± 2189.3. Roberts et al. did not report this data.

The statistical analysis indicated that compression with hemostatic agents was associated with a significantly reduced TAH (MD −86.59 min; 95% CI −106.88 to −66.30; p < 0.01; I² = 98%; Figure 2 A) compared to compressions without hemostatic agents. There was no statistical difference between the methods regarding 24-RAO (RR 0.72; 95% CI 0.44 to 1.19; p = 0.20; I² = 35%; Figure 2 B), failure to achieve hemostasis (RR 0.52; 95% CI 0.20 to 1.35; p = 0.18; I² = 94%; Figure 2 C), and hematoma occurrence (RR 1.16; 95% CI 0.84 to 1.60; p = 0.37; I² = 4%; Figure 2 D).

Main analysis. All compressions with hemostatic agents (HA) compared to all compressions without hemostatic agents (WHA). (A) Radial artery compression utilizing HA significantly shortened the time to achieve hemostasis compared to compression WHA. (B) Radial artery compression with HA did not result in a statistically significant difference in 24-hour radial artery occlusion (24-RAO) compared to compression WHA. However, when limited to manual compression techniques, the use of HA was associated with a statistically significant reduction in 24-RAO relative to WHA. (C) Radial artery compression with HA did not result in a statistically significant difference in failure to achieve hemostasis compared to compression WHA. (D) Radial artery compression with HA did not result in a statistically significant difference in hematoma occurrence compared to compression WHA.

The manual compression with hemostatic agents subgroup significantly reduced 24-RAO (RR 0.46; 95% CI 0.27 to 0.78; I² = 0%; Figure 2 B).

The summary of findings is reported in Figure 3 .

Only gold members can continue reading. Log In or Register to continue

Share this:

• X
• Facebook

Related

Related posts:

1. Unmasking Myocardial Bridge–Related Ischemia by Quantitative Flow Ratio Functional Evaluation
2. Comparison of Anatomical and Physiological Indices of Angiographically Intermediate Left Main Coronary Artery Stenoses
3. Systematic Review and Meta-analysis of Short-Term Outcomes in Patients Following Protected High-Risk PCI
4. Outcome of Functional Mitral Regurgitation Associated With Heart Failure with Mildly Reduced or Preserved Ejection Fraction

Stay updated, free articles. Join our Telegram channel

Join