Protamine-Facilitated Same-Day Discharge Following Distal Transradial Angiography

BACKGROUND: Despite growing adoption of distal transradial approach (dTRA), data on same-day discharge with protamine-assisted hemostasis following coronary angiography (CAG) remain limited. This pilot study investigated its safety and feasibility. METHODS: From January 2022 to September 2024, a total of 34 patients who were discharged on the same-day after elective CAG via dTRA in our center were included, as well as 34 matched patients who underwent CAG via standard transradial approach (sTRA) during the same period. Protamine was administrated after CAG in the dTRA group. Multivariable regression models were conducted to analyses the correlation between different radial artery accesses and clinical variables. The primary endpoint was time to hemostasis, and secondary endpoints were costs and procedure duration. The safety endpoints were the incidences of bleeding-related complications. RESULTS: All patients underwent CAG with successful insertion of a 6 F sheath in both groups. The number of punctures and puncture duration were similar between the two groups. Compared with the sTRA group, the dTRA group had a significantly shorter hemostasis time (1.3 h vs. 5.9 h, p < 0.001) and a lower hospital cost (12.8 vs. 14.6 (CNY × 10³), p = 0.020). Procedure duration did not differ between the two groups. No bleeding-related complications on the access site were seen in both groups. There were two cases of radial artery occlusion in dTRA group and three cases in sTRA group 1 month after discharge. Multivariable regression analysis showed that dTRA significantly shortened hemostasis time (β -3.1, 95% CI -3.8 ~ -2.3, p < 0.001) with a reduction in costs (β -3.3, 95% CI -5.400 ~ -1,200, p = 0.004, (CNY ×10³)). CONCLUSIONS: Same-day discharge after dTRA CAG with protamine was feasible and safe, achieving significantly reduced hemostasis time and costs compared to sTRA. TRIAL REGISTRATION: As an observational cohort, this study was not prospectively registered in a clinical trial registry.