The radial artery receives a short anticoagulation after the catheter access

BOSTON – Brief treatment with rivaroxaban (Xarelto) after transradial coronary procedures helped prevent complications of radial artery occlusion, the RIVARAD study from Tunisia showed.

Direct-acting oral anticoagulant (DOAC) reduced 30-day radial artery occlusion by half (6.9% vs. 13%; OR 0.50, 95% CI 0.27-0.91), reported Rania Hammami, MD, from Hedi Chaker Hospital in Sfax, Tunisia, at the Transcatheter Cardiovascular Therapeutics (TCT) meeting hosted by the Cardiovascular Research Foundation.

Hemorrhagic complications were numerically more frequent with the 7-day treatment with rivaroxaban, but not significantly (2.70% vs. 1.90% at 30 days; P=0.54), she explained. Most events were minor (2.3% BARC 1) and no bleeding events occurred in patients receiving rivaroxaban without an antiplatelet agent.

Hammami noted that the population studied in Tunisia is at particularly high risk of radial artery occlusion due to a high rate of risk factors such as smoking, diabetes and dyslipidemia. However, she stated that the most recent randomized trial showed a prevalence of radial artery occlusion ranging from 8% to 10%, similar to her control arm.

“This is a pretty important artery,” noted Roxana Mehran, MD, panellist at the TCT press conference from Mount Sinai School of Medicine in New York City. Now that the use of radial arteries has received a Class I indication for bypass surgery, “we need to preserve these arteries” so that future procedures don’t have to resort to the less durable vein grafts, she stressed.

“With good radial artery access, the rate of radial artery occlusions should be almost zero,” she said. “But shall we look at this? … We ‘heparinize’ the patients, we give all kinds of good anticoagulants during the procedure. But this idea of ​​using a direct oral anticoagulant periprocedurally is a good one.”

Hammami found that approximately 36% to 56% of operators do not assess radial artery patency prior to discharge, and half do not use ultrasound, based on previous surveys.

Rivaroxaban was selected based on research showing that it is more effective than aspirin at maintaining endothelial function, Hammami noted, but it’s not yet clear if there might be a class effect between DOACs.

The relatively short course of rivaroxaban was probably a wise choice because it is a convenient anticoagulant that can be administered once a day, suggested Eric A. Cohen, MD, panelist at the TCT press conference from the Schulich Heart Program at Sunnybrook Health Sciences Center toronto before. He called the results “intriguing,” but said more information was needed about bleeding, especially since many patients are receiving dual antiplatelet therapy.

The study excluded patients at high risk of bleeding, Hammami noted, but additional information comes from the ongoing CAPITAL-RAPTOR study from Canada, in which 1,800 patients were randomized to receive 15 mg of rivaroxaban or standard care without anticoagulation after transradial procedures.

A similar concept would be interesting for use in transcatheter aortic valve replacement (TAVR), particularly to combat the risk of stroke, Mehran suggested. “You always worry about bleeding if you add more, but that’s a low dose.”

The study involved 538 patients with a mean age of 60 years who underwent transradial coronary angiography or percutaneous coronary intervention with anticoagulants in five Tunisian medical centers from November 2021 to March 2022.

32% of participants were female, a known predictor of radial artery occlusion. More than 50% had more than 6 hours to hemostasis. A quarter had previously had transradial surgery, almost half were smokers and almost half had diabetes.

People who received ticagrelor (Brilinta) or prasugrel (Efient) were excluded.

Hammami noted that no locking devices were used, only classic manual compression, reflecting real and real practice in Tunisia.