The postoperative compression time is still significantlylonger than the recommended range via distal transradial access (dTRA) inpractice. Previous studies have confirmed the safety and effectiveness of protaminesulfate to improve hemostasis in patients after coronary intervention by antagonizingheparin.

The study isretrospective. Cases were collected from July 2021 to October 2022 in FuwaiHospital, Chinese Academy of Medical Sciences. The cases of coronaryangiography performed via dTRA and intravenous protamine before removal werecollected as the study group, and cases that underwent coronary angiographyalone via the distal radial artery during the same period were collected as thecontrol group. All patients have signed written informed consent to the therapyand consent to participate in this study. The study has been approved by theEthics Committee of Fuwai Hospital of the Chinese Academy of Medical Sciences (ApprovalNo: 2023-1998).The primary endpoint ofthe study was postoperative compression time at the puncture site aftercoronary angiography. Secondary endpoints were radial artery occlusion, BARC type2, type 3, and 5 bleeding, bleeding at the puncture site after removal ofcompression, hematoma of the upper extremity, loss of pulsation of the radialartery and distal radial artery, systemic embolism. Exploratory endpoints wereupper extremity abnormal movement and paresthesia, thumb dysfunction, andradial artery thrombosis confirmed by ultrasound of the radial artery.The electronic medicalrecord system was used to retrieve the medical records of coronary angiographyperformed via dTRA alone from July 2021 to October 2022 in Fuwai Hospital,Chinese Academy of Medical Sciences.Alldata were collated by IBM SPSS 26.0 and stored for further analysis.  P < 0.05 was considered statisticallysignificant.

A total of 97 patients in protamine group and 293 incontrol group were enrolled. Intraoperative heparin use, contrast dose,contrast time and radiation dose were not statistically different between thetwo groups. The mean compression time of the control group was 2.9±0.5 hours,while that of the protamine group was 1.6±0.9 hours (p < 0.001). There wasno significant difference in postoperative minor and major hemorrhage andhematoma between the two groups. Ultrasound 24 hours after angiography showedthat the incidence of radial artery thrombosis was 1.1% in the control groupand 4.3% in the protamine treatment group with no statistical differencebetween the two groups (p=0.209), and there was no radial artery occlusion ineither group. Logistic regression suggested that radial artery thrombosis wasassociated with intraoperative heparin dose and history of chronic kidneydisease.
Main Table: Post Operative Indicators

	Control Group (N=293)	Protamine Group (N=97)	P value
Primary Endpoint Compression duration(hour)	2.9±0.5	1.6±0.9	＜0.001
Secondary Endpoints
Loss of radial artery pulse(n,%)	0	0	-
Radial artery occlusion	0/94	0/92	-
Hemorrhage(n,%) (BARC type 2,3&5)	0	0	-
Puncture site minor bleeding (n,%)	3，1.0%	3，3.1%	0.105
Forearm hematoma(n,%)	1，0.3%	0	1
Loss of distal radial artery pulse(n,%)	0	0	-
Systemic embolism(n,%)	0	0	-
Other Endpoints
Forearm dyskinesia(n,%)	0	0	-
Forearm dysesthesia(n,%)	3，1.0%	2，2.1%	0.593
Thumb dysfunction(n,%)	1，0.3%	0	1
Radial artery thrombosis rate	1/94（1.1%）	4/92（4.3%）	0.209

In summary, we found thatintravenous administration of protamine sulfate after coronary angiography viadistal transradial access can significantly shorten the postoperativecompression time, and has good safety, without drug-related adverse reactions,serious bleeding and embolization events.