The Effect of Procoagulants on Radial Artery Cardiac Catheterization Outcomes: A Systematic Review and Network Meta-Analysis

Abstract

ABSTRACTObjective: To systematically compare and rank the efectiveness of diferent procoagulants and radial artery compression methodsin achieving successful haemostasis and improving vascular outcomes following radial artery catheterization.Methods: A systematic strategy was employed to identify published and unpublished clinical trials from PubMed, CINAHL,Scopus, Web of Science, Embase and Cochrane Trials until March 2025. A network meta-analysis was conducted to compare therelative efectiveness of the interventions using frequentist framework and random efects model using the MetaInsight software.Results: Fourteen clinical trials involving 6661 participants were included. In direct comparisons, kaolin dressings applied for120 min had successful haemostasis compared with standard bandage (RR 1.11, 95% CI 1.01–1.21, very low certainty), whilepotassium ferrate hydrophilic polymer (PFHP) combined with a pneumatic compression device (PCD) for 60 min was superior toPCD alone for 60 min (RR 2.49, 95% CI 2.26–2.75, very low certainty). Several procoagulants signifcantly reduced time tohaemostasis compared with PCD for 120 min, including kaolin (30 min: MD –118.7 min, 95% CI - 198.9 to - 38.5 moderatecertainty; 60 min: MD - 88.5 min, 95% CI - 168.7 to - 8.3, very low certainty), chitosan (60 min: MD - 113.0 min, 95% CI - 212.6 to -13.3, moderate certainty) and PFHP þ PCD (60 min: MD - 96.1 min, 95% CI -148.9 to - 43.3, low certainty). Chitosan dressings(60 min) reduced the risk of radial artery occlusion (RAO) compared with PCD for 60 min (RR 0.49, 95% CI 0.28–0.85, moderatecertainty). Network meta-analyses were frequently fragmented, and no intervention demonstrated superiority over PCD for120 min for successful haemostasis, haematoma, bleeding or RAO. Study numbers per outcome were limited, and heterogeneitywas substantial, resulting in low certainty of evidence; fndings should therefore be interpreted as hypothesis-generating ratherthan practice-defning.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided theoriginal work is properly cited.Copyright © 2026 Ritin Fernandez et al. Journal of Interventional Cardiology published by John Wiley & Sons Ltd.Journal of Interventional Cardiology, 2026; 2026:7672958 1 of 12https://doi.org/10.1155/joic/7672958Journal of Interventional Cardiology