The Effect of Using a High Heparin Dose versus a Standard Heparin Dose on the Quality and Safety of Cardiac Patients Following Diagnostic Trans-Radial Coronary Angiography at Palestine: An Experimental Study رسالة دكتوراة

Abstract

Background: Cardiovascular disease (CVD) is the major cause of death worldwide, causing about 80%–86% of mortalities in low- and middle-income nations. Coronary angiography is the main method for the diagnosis of CHD and an invasive technique for the management of CHD with cardiovascular medications. Trans-radial coronary angiography (TCA) has the advantages of earlier recovery, a shorter time during a stay in the hospital, lower damage to the human body, and decreases postoperative complications. Trans-radial (TR) coronary angiography (CAG) and percutaneous coronary interventions (PCIs) are becoming increasingly popular worldwide, TCS might have some complication like radial artery occlusion (RAO); it may cause by thrombus formation, hematoma may appear in the puncture site. Aim: This study aimed to investigate the effectiveness of using a high heparin dose (5000IU-7000IU or 100IU/kg) contrasted with a standard heparin dose (2000IU-3000IU or 50IU/kg) on the quality and safety of cardiac patients’ post-trans-radial coronary angiography. Methodology: A randomized controlled trial (RCT) was conducted between April and August 2023, including posttest, and follow-up to find a cause-and-effect association between an independent and dependent variable. The study conducted at Specialized Arab Hospital (SAH) with targeted participants, any patient admitted for cardiac catheterization in the SAH who met the inclusion criteria, the final sample was 289 participants, 143 participants received standard heparin dose and 146 received high heparin dose. Result: the findings assured the quality and safety of care of using high dose of heparin among trans-radial catheterization as there are no statistically significant differences VI between the dose of heparin (high vs. standard) and the Trans-radial Band (TRB) removal time, hospital stay, occlusion occurrence, occurrence of hematoma, abnormal sensation among standard dose group in compare with high heparin dose group. Moreover, statistical tests showed that there is a statistically significant relationship between the dose of the heparin and the occurrence of ischemia after the fourth hour and after a month of catheterization. (34.820 X2) (P: 0.001), (34.820 X2) (P0.001) respectively. Although the average time of TRB removal time for patients taking the high dose of heparin was slightly higher than the average TRB removal time for patients taking the standard dose (3.36 versus 3.22 respectively). Also, the hospital stay rate was slightly higher among patients taking the usual dose of heparin compared to patients taking the high dose of heparin. As for the patient's feeling of pain, the feeling of pain a month after the catheterization procedure was higher among patients taking the high dose of heparin compared to patients taking the usual dose of heparin. While the pain average for patients taking the standard dose of heparin was higher than the pain average for patients taking the high dose of heparin after the second and fourth hours of the catheterization procedure. Finally, the satisfaction (quality of care) rate among participants from the two categories (the usual dose and the high dose of heparin) is 4.06 out of 5, and this reflects a high level of satisfaction with the care provided. Conclusion: Quality and safety of health care are a priority these days, which is also what this dissertation aims to achieve. Through this dissertation results, we find that the use of high doses can be adopted by hospitals that perform cardiac catheterization, as well as to be part of the instructions and guidelines. The administration of a high heparin dose during VII TRA diagnostic procedures resulted in a striking reduction of early radial artery occlusion (RAO) rates compared with a standard anticoagulation regimen. The beneficial results produced by the use of high-dose heparin were found to be without an increase in major bleeding. Also, the current study confirmed that there is no statistically significant difference between patients taking the standard dose and patients taking the high dose of heparin with the occurrence of hematoma.