Design and rational of the the PRACTICAL-HERO trial: A randomized trial of higher and lower doses of heparin vs placebo for elective diagnostic coronary angiography.

RATIONALE: Radial artery occlusion (RAO) and bleeding are the principal complications of transradial cardiac catheterization. Although unfractionated heparin (UFH) reduces RAO, it may increase bleeding risk; thus, the optimal balance between efficacy and safety remains uncertain.

PRIMARY HYPOTHESIS: Among patients undergoing transradial coronary angiography, UFH (high-dose 50 U/kg or low-dose 25 U/kg) compared with placebo reduces RAO, assessed by Doppler ultrasound prior to discharge.

DESIGN

Multicenter, randomized, controlled trial comparing high-dose UFH, low-dose UFH, and placebo. Patients undergo standardized radial hemostasis (30-minute compression followed by stepwise 20-minute release). Net clinical benefit defined as composite of RAO and hematoma ≥5 cm.

CLINICAL TRIAL REGISTRATION: URL: www.

CLINICALTRIALS: gov; Unique identifier: NCT04374799.