Elevated white blood cell count is associated with clot formation within arterial sheaths and may be a risk factor for thromboembolic complication during transradial cerebral angiography

Abstract

Objectives: The transradial approach for diagnostic cerebral angiography is feasible, safe, and commonly used. To prevent neurological complications, unfractionated heparin (UFH) is often administered. However, the appropriate dose and administration method have not been established yet. In addition, factors that attenuate UFH efficacy during the procedure have not been examined. We determined the effect of intravenous bolus UFH administration on clot formation within arterial sheaths and the risk factors for clot formation during transradial diagnostic cerebral angiography.
Methods: We retrospectively reviewed 50 patients who underwent diagnostic transradial cerebral angiography with UFH between January 2012 and October 2013. The patients were divided into the clot and no-clot groups on the basis of clot formation in the sheath after the procedure. The patient characteristics, past medical history, reason for undertaking the procedure, dose of UFH, activated clotting time (ACT), neurological complications, and laboratory results were analyzed.
Results: Clots occurred in 60% of the patients, with no symptomatic ischemic events. About 2,000 units of UFH were intravenously administered after sheath placement. In both groups, ACT increased significantly after UFH administration, but the elevation ratio was higher in the no-clot group. White blood cell (WBC) counts and serum total protein were significantly higher in the clot group. WBC counts above the reference range increased the risk of clot detection (risk ratio, 1.77, 95% confidence interval, 1.24–2.54).
Conclusion: Elevated WBC count may predict UFH insensitivity and be a risk factor for thromboembolic complications during transradial cerebral angiography with intravenous administration of 2,000 units of UFH.