Prevention of Radial Artery Occlusion With Rivaroxaban After Transradial Coronary Procedures - RIVARAD

Sep 19, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Philadelphia Pharma (Tunisia)
Date Presented:
09/19/2022
Date Published:
09/19/2022
Date Updated:
09/19/2022
Original Posted Date:
09/19/2022
References

Contribution To Literature:

The RIVARAD trial showed that 7 days of rivaroxaban may prevent radial artery occlusion.

Description:

The goal of the trial was to evaluate rivaroxaban compared with control among individuals who underwent cardiac catheterization by transradial access.

Study Design

  • Randomized
  • Parallel
  • Open-label

Individuals who underwent cardiac catheterization by transradial access were randomized to rivaroxaban 10 mg daily for 7 days (n = 259) versus control (n = 262). After radial artery access was obtained, verapamil 2.5 mg and nitroglycerin 200 mcg were given intra-arterial. Unfractionated heparin was given at a dose of 50 units/kg for diagnostic coronary angiography and 70-100 units/kg for percutaneous coronary intervention (PCI). After the procedure, a manual compression band was applied.

  • Total number of enrollees: 521
  • Duration of follow-up: 30 days
  • Mean patient age: 60 years
  • Percentage female: 32%
  • Percentage with diabetes: 48%

Inclusion criteria:

  • Individuals 18-80 years of age who underwent coronary angiography or PCI by transradial access

Exclusion criteria:

  • Use of thrombolytic therapy or glycoprotein IIb/IIIa inhibitor
  • Radial artery complication
  • Staged intervention within 30 days
  • High-risk for bleeding, contraindication to anticoagulation, or thrombocytopenia
  • Hemodynamic instability
  • Prior intracranial hemorrhage
  • Ischemic stroke or transient ischemic attack (TIA) within the last 3 months
  • Liver disease
  • Chronic kidney disease
  • Weight <50 kg

Other salient features/characteristics:

  • Overall incidence of radial artery occlusion: 10%

Principal Findings:

The primary outcome, radial artery occlusion assessed by ultrasound at 30 days, occurred in 6.9% of the rivaroxaban group vs. 13% of the control group (p = 0.011).

Secondary outcomes:

  • Hemorrhagic complication: 2.7% in the rivaroxaban group vs. 1.9% in the control group (p = 0.54)
  • Predictors of radial artery occlusion: female, current smoking, prior transradial procedure

Interpretation:

Among individuals who underwent coronary angiography or PCI by transradial access, 7 days of rivaroxaban was associated with a reduction in radial artery occlusion at 30 days. Hemorrhagic complications were numerically higher in the rivaroxaban group. Limitations of this trial include open-label design, modest dose of procedural unfractionated heparin, and nonuse of patent hemostasis. Validation of this treatment strategy is required before this could be adopted as best practice.

References:

Presented by Dr. Rania Hammami at the Transcatheter Cardiovascular Therapeutics meeting (TCT 2022), Boston, MA, September 19, 2022.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Anticoagulation Management and ACS, Interventions and ACS, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging, Smoking

Keywords: Acute Coronary Syndrome, Anticoagulants, Cardiac Catheterization, Coronary Angiography, Coronary Occlusion, Hemostasis, Heparin, Nitroglycerin, Percutaneous Coronary Intervention, Radial Artery, Rivaroxaban, Secondary Prevention, Smoking, TCT22, Transcatheter Cardiovascular Therapeutics, Ultrasonography, Verapamil


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