Rivaroxaban may be an option for reducing radial artery occlusion in transradial coronary procedures

Rania Hammami

The use of rivaroxaban for seven days after a transradial coronary procedure reduced the rate of radial artery occlusion, findings of the RIVARAD multicentre randomised trial, presented at the 2022 Transcatheter Cardiovascular Therapeutics meeting (TCT, 16–19 September, Boston, USA) have shown.

Presenting author Rania Hammami (Hedi Chaker Hospital, Sfax, Tunisia) detailed the findings of the study from five Tunisian centres, which she claimed could impact routine practice by providing a new strategy to reduce radial artery occlusion following transradial access. Radial artery occlusion is the most frequent complication of a transradial procedure, Hammami said, precluding the artery’s future use as an access site for future coronary procedures, coronary artery bypass grafting (CABG) or fistula for haemodialysis.

Through the study, eligible patients aged between 18–80 years were randomised to receive either 10mg of rivaroxaban for seven days following a transradial percutaneous coronary intervention (PCI) or coronary angiography procedure, or to receive the current standard of care. Exclusion criteria included the use of thrombolytic therapy or glycoprotein IIb/IIa inhibitors, radial artery complication, high bleeding risk, or haemodynamic instability.

All procedures took place between November 2021 and March 2022, and operators had at least five years of experience with transradial procedures to take part in the investigation.

Investigators tracked the rate of radial artery occlusion seen at 30 days, assessed by ultrasound examination in the wrist, as the study’s primary endpoint, while secondary endpoints included the incidence of haemorrhagic events at the same timepoint, defined according to the Bleeding Academic Research Consortium (BARC) criteria, and local complications on the puncture point including aneurysm, haematoma and arteriovenous fistula.

A total of 538 patients were randomised to the two study groups, 269 patients to the rivaroxaban arm and 269 to the control group. Follow-up data were available for 521 patients, 259 patients in the rivaroxaban group and 262 patients in the control group. Demographic and clinical characteristics of the patient population revealed an average age of 59.7 years among the two patient groups, with 32% female patients, 47% current smokers and 48.1% diabetics.

Reporting the study’s results, Hammami told TCT attendees that the overall incidence of radial artery occlusion seen in the study was 10%, occurring in 6.9% of patients in the rivaroxaban group and 13% in the control group (95% confidence interval [CI] 0.27–0.91, odds ratio [OR]=0.5, p=0.011). The incidence of haemorrhagic complications seen at 30 days was slightly higher in the rivaroxaban group (2.7% vs. 1.9%, 95% CI 0.44–4.5, OR=1.4, p=0.54), though this was not statistically significant.

Limitations of the study, according to Hammami, included that best practice for the radial approach—such as compression of the ipsilateral ulnar artery or the use of patent haemostasis—were not always observed, however she acknowledged that this reflects the hectic nature of real-world clinical practice.

The findings prompted Hammami to conclude that use of rivaroxaban could be a good option to prevent radial artery occlusion, particularly where ambulatory procedures are increasing, though she cautioned that interventional cardiologists must take more care to implement preventive measures by using best practices for transradial access.


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