A randomised control trial to compare conventional and haemostatic dressings in radial arterial access: Assessment of Radial Artery Complications Whilst Achieving Rapid Haemostasis (ARCH Trial).

OBJECTIVES: This trial aimed to compare conventional and haemostatic dressings in achieving rapid and effective radial artery haemostasis following coronary procedures. BACKGROUND: In small studies, using a haemostatic dressing is associated with expedited haemostasis and a reduced duration of external radial compression. METHODS: Patients were randomised to one of three compression strategies: 120-min (min) with conventional dressing (C2) vs 60-min with conventional dressing (C1) vs 60-min with haemostatic dressing (H1). The primary outcome was failure to achieve haemostasis at the planned time. The secondary outcomes included: total time-to-final haemostasis (TTH); subsequent radial artery occlusion (RAO), puncture-related haematoma and vascular injury requiring repair; incidence of delayed discharge due to prolongation of radial access site care. RESULTS: A total of 2114 patients were randomised. At the planned time, 62 % of patients in C1 and 50 % in C2 failed to achieve haemostasis vs 5.2 % in H1 (P < 0.001 for H1 vs C2 or C1). Median (IQR) TTH was 72 mins [68-81 min] in H1, 136 mins [80-189] in C1, and 166 min [133-213] in C2 (P < 0.001 for H1 vs C2 or C1). No significant differences were seen in access-site complications, with low rates of haematomas >5 cm and RAO. Overall, 16.2 % of patients in C2 and 15.8 % in C1 experienced delayed discharge exclusively due to prolonged radial care vs 2.0 % in H1 (P < 0.001 for H1 vs C2 or C1). CONCLUSIONS: The use of the haemostatic dressing allowed for more rapid, consistent and safe haemostasis, reducing nursing care requirements and incidence of delayed discharge.