Method to stop bleeding, with short hemostasis duration using a low dose of anticoagulant

Abstract

Disclosed are methods and devices for obtaining patent hemostasis of the radial artery by compressing the uninstrumented ulnar artery to increase radial artery flow. The device comprises a band having an inflatable bladder for applying blunt pressure to the ulnar artery. The method comprises applying a pressure to the homolateral ulnar artery and applying a pressure to the radial artery at the access site to obtain hemostasis at the access site.

1 . A method of attaining hemostasis of a radial artery of a patient after performing a catheterization procedure at an access site on the radial artery, comprising performing the following steps:
 (a) compressing the radial artery at or near the access site to stop bleeding;   (b) compressing an ipsilateral ulnar artery fully;   (c) testing the radial artery for patency after a first period of time;   (d) if the radial artery is found patent in step (c), reducing an ulnar pressure on the ulnar artery to partially compress the ulnar artery;   (e) if the radial artery is found not patent in step (c), keeping the ulnar artery fully compressed;   (f) testing the radial artery for patency after a second period of time;   (g) if the radial artery is found not patent in step (f), reducing a radial pressure on the radial artery until bleeding starts and then increasing compression slightly to stop bleeding;   (h) applying the ulnar pressure on the ipsilateral ulnar artery to partially compress the ipsilateral ulnar artery after the second period of time; and   (i) compressing the radial artery until hemostasis is attained at the access site.   
     
     
         2 . The method of  claim 1 , wherein the ulnar pressure is applied to compress the ipsilateral ulnar artery in step (h) until hemostasis is attained at the access site of the radial artery. 
     
     
         3 . The method of  claim 1 , wherein the ulnar pressure in step (h) is reduced to zero before hemostasis of the radial artery. 
     
     
         4 . The method of  claim 1 , wherein the radial pressure on the radial artery is applied by inflating at least a first bladder. 
     
     
         5 . The method of  claim 1 , wherein the ulnar pressure on the ulnar artery is applied by inflating at least a second bladder. 
     
     
         6 . The method of  claim 1 , wherein step (b) precedes step (a). 
     
     
         7 . The method of  claim 1 , wherein an introducer sheath used in the catheterization procedure is removed after step (b). 
     
     
         8 . The method of  claim 1 , wherein the ulnar pressure site is a Guyon's canal. 
     
     
         9 . The method of  claim 1 , further comprising administering a dose of an anticoagulant at any time before introduction of a catheter or an introducer sheath, or administering the anticoagulant at any time after introduction of a catheter or an introducer sheath and before removal of the catheter or the introducer sheath. 
     
     
         10 . The method of  claim 9 , wherein the anticoagulant is selected from a group consisting of: heparin, dalteparin, danaparoid, enoxaparin, unfractionated heparin, low molecular weight heparin, direct thrombin inhibitors including hirudin, argatroban, bivalirudin, and combinations or derivatives thereof. 
     
     
         11 . The method of  claim 9 , wherein the dose of the anticoagulant is less than an equivalent of about 50 units of unfractionated heparin per kg of body weight. 
     
     
         12 . The method of  claim 1 , wherein the first period of time in step (c) is about 15 minutes and the second period of time in step (f) is about 30 minutes, the time being measured from the moment the ulnar artery was fully compressed. 
     
     
         13 . The method of  claim 1 , wherein the radial pressure and the ulnar pressure are applied using a band comprising at least two inflatable bladders, wherein at least a first bladder applies the radial pressure and at least a second bladder applies the ulnar pressure. 
     
     
         14 . A method of attaining hemostasis of a radial artery of a patient after performing a catheterization procedure at an access site on the radial artery, comprising performing the following steps:
 (a) compressing the radial artery at or near the access site to stop bleeding;   (b) compressing an ipsilateral ulnar artery fully;   (c) testing the radial artery for patency after a first period of time;   (d) if the radial artery is found not patent in step (c), reducing a radial pressure on the radial artery until bleeding starts and then increasing compression slightly to stop bleeding;   (e) testing the radial artery for patency after a second period of time;   (f) if the radial artery is found not patent in step (e), reducing a radial pressure on the radial artery until bleeding starts and then increasing compression slightly to stop bleeding;   (g) applying the ulnar pressure on the ipsilateral ulnar artery to partially compress the ipsilateral ulnar artery after the second period of time; and   (h) compressing the radial artery until hemostasis is attained at the access site.   
     
     
         15 . The method of  claim 14 , wherein the ulnar pressure is applied to compress the ipsilateral ulnar artery in step (g) until hemostasis is attained at the access site of the radial artery. 
     
     
         16 . The method of  claim 14 , wherein the ulnar pressure in step (g) is reduced to zero before hemostasis of the radial artery. 
     
     
         17 . The method of  claim 14 , wherein the radial pressure on the radial artery is applied by inflating at least a first bladder. 
     
     
         18 . The method of  claim 14 , wherein the ulnar pressure on the ulnar artery is applied by inflating at least a second bladder. 
     
     
         19 . The method of  claim 14 , wherein step (b) precedes step (a). 
     
     
         20 . The method of  claim 14 , wherein an introducer sheath used in the catheterization procedure is removed after step (b). 
     
     
         21 . The method of  claim 14 , wherein the ulnar pressure site is a Guyon's canal. 
     
     
         22 . The method of  claim 14 , further comprising administering a dose of an anticoagulant at any time before introduction of a catheter or an introducer sheath, or administering the anticoagulant at any time after introduction of a catheter or an introducer sheath and before removal of the catheter or the introducer sheath. 
     
     
         23 . The method of  claim 22 , wherein the anticoagulant is selected from a group consisting of: heparin, dalteparin, danaparoid, enoxaparin, unfractionated heparin, low molecular weight heparin, direct thrombin inhibitors including hirudin, argatroban, bivalirudin, and combinations or derivatives thereof. 
     
     
         24 . The method of  claim 22 , wherein the dose of the anticoagulant is less than an equivalent of about 50 units of unfractionated heparin per kg of body weight. 
     
     
         25 . The method of  claim 14 , wherein the first period of time in step (c) is about 15 minutes and the second period of time in step (e) is about 30 minutes, the time being measured from the moment the ulnar artery was fully compressed. 
     
     
         26 . The method of  claim 14 , wherein the radial pressure and the ulnar pressure are applied using a band comprising at least two inflatable bladders, wherein at least a first bladder applies the radial pressure and at least a second bladder applies the ulnar pressure.