Prevention of Radial Artery Occlusion With Rivaroxaban After Transradial Coronary Procedures - RIVARAD
Contribution To Literature:
The RIVARAD trial showed that 7 days of rivaroxaban may prevent radial artery occlusion.
The goal of the trial was to evaluate rivaroxaban compared with control among individuals who underwent cardiac catheterization by transradial access.
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%
- Individuals 18-80 years of age who underwent coronary angiography or PCI by transradial access
- 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%
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).
- 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
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.
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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