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Abstract

The radial artery has become the preferred access site for coronary catheterization worldwide due to its association with lower bleeding risk, enhanced patient comfort, and early ambulation compared to femoral access. Its adoption is increasing steadily across low- and middle-income countries, including Pakistan. However, even with radial access, complications such as forearm hematomas can occur and should not be overlooked.
In this context, the study by Khattak et al. [1] offers important insights by evaluating the incidence and predictors of forearm hematoma in over 3,000 patients undergoing transradial coronary procedures at the Peshawar Institute of Cardiology. The authors report a remarkably low overall hematoma rate of 0.8%, a figure notably lower than that reported in several international series. This likely reflects meticulous technique, skilled operators, and vigilant post-procedural care at the study center.
Importantly, the analysis identifies female gender, hypertension, and the performance of percutaneous coronary intervention (PCI) as independent risk factors for hematoma formation, whereas age and diabetes did not show significant associations. These findings align partially with global literature while emphasizing population-specific risk stratification. Notably, while most hematomas were minor, a small subset (Grade 3 and 4) required medical intervention—underscoring that even a “minor” complication can escalate and deserves clinical vigilance.
One of the strengths of this study lies in its local relevance. Much of the existing data on radial access complications come from Western populations, where patient demographics, procedural infrastructure, and operator experience may differ significantly. By offering granular, context-specific data, this study helps guide local clinical practice and highlights areas where preventive strategies could be targeted more effectively.
Future studies should explore the role of procedural refinements, vascular closure devices, and real-time imaging techniques in further reducing the incidence of access site complications. A national registry on radial access outcomes could also help standardize care and facilitate benchmarking across centers.
Overall, the study by Khattak et al. [1] reaffirms the safety profile of radial access in cardiac catheterization within the local context and serves as a timely reminder that vigilance for even infrequent complications remains essential for optimal patient outcomes.
References
Khattak SN, Waleed M, Ullah A, Raja F, Waleed M. Prevalence and Risk Factors of Forearm Hematoma Following Radial Access Cardiac Catheterization: A Cross-Sectional Study. Pak Heart J. 2025;58(02):104-105. DOI: 10.47144/phj.v58i2.2891