{"id":131364,"date":"2022-09-19T14:41:01","date_gmt":"2022-09-19T18:41:01","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=131364"},"modified":"2022-09-19T14:41:01","modified_gmt":"2022-09-19T18:41:01","slug":"rivarad-post-procedural-rivaroxaban-use-after-radial-access-for-coronary-procedures-reduces-radial-artery-occlusion-at-30-days","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=131364","title":{"rendered":"RIVARAD: Post-Procedural Rivaroxaban Use After Radial Access for Coronary Procedures Reduces Radial Artery Occlusion at 30 Days"},"content":{"rendered":"<p>Key Points:<\/p>\n<ul>\n<li>Radial artery occlusion (RAO) is the most common complication after radial access for coronary procedures; while routine intra-procedural heparin administration is a protective factor, the role of post-procedural anticoagulation has not been established.<\/li>\n<li>In the RIVARAD study, patients undergoing trans-radial access for coronary procedures were randomized to a week of post-procedural rivaroxaban vs no additional treatment. The primary outcome of interest was 30-day incidence of RAO by ultrasound.<\/li>\n<li>Patients receiving rivaroxaban experienced a 50% reduction in RAO by ultrasound and a 52% reduction in RAO by palpation compared to the control group. Rivaroxaban use was safe with no increase in overall hemorrhagic complications relative to the control arm.<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p>Radial artery occlusion (RAO) is the most frequent complication of radial access for coronary angiography and ultimately leads to exclusion of that artery for later access. While adequate intra-procedure anticoagulation has been established as a preventative measure, the role of post-procedure anticoagulation has not yet been examined. In a breaking presentation at the 2022 TCT Conference today, <a href=\"https:\/\/orcid.org\/0000-0003-1168-6450\">Dr. Rania Hammami<\/a> (Hedi Chaker Hospital, Tunisia) and her team presented their study: \u201cPrevention of Radial Artery Occlusion With Rivaroxaban After Transradial Coronary Procedures,\u201d or the RIVARAD trial.<\/p>\n<p>The RIVARAD study was a prospective, open-label, randomized clinical trial conducted across 5 centers in Tunisia which evaluated the effects of a prophylactic period of rivaroxaban (10mg daily x 7 days) post radial access to prevent RAO. The inclusion criteria comprised adults undergoing radial access for diagnostic coronary angiography or PCI; relevant exclusions included radial artery access failure, local radial complications, thrombolytic therapy within 24 hours, or contraindications to anticoagulation. A total of 538 patients were randomized (after completion of the procedure) to either rivaroxaban or no additional treatment. All patients received an ultrasound examination for RAO at 30 days; patients requiring further angiographic procedures for ACS were then excluded (17 total). The mean age was 60, and 32% of patients were female. 25.7% of patients had prior trans-radial procedures, and 7.29% had known peripheral arterial disease. Separately from the rivaroxaban, 47% of patients received DAPT post procedure, and 41% received only aspirin therapy. 48.7% patients had &gt;1 puncture attempted, and 13.2% had no radial pulse at discharge.<\/p>\n<p>The primary outcome was incidence of RAO by ultrasound at 30 days, and the overall incidence was 10%. Patients receiving rivaroxaban experienced lower rates of RAO (13% vs 6.9%; OR 0.5, 95% CI 0.27-0.91, p= 0.011). Additionally, patients in the rivaroxaban group were less likely to have a non-palpable radial artery pulse at 30 days (12.2% vs 5.8%, p =0.01). With regards to bleeding, 2.3% of patients experienced minor (BARC 1) bleeding, with no severe hemorrhagic complications; there was no significant difference in overall hemorrhagic complications between the two groups. Female sex, current smoking status, and prior trans-radial procedures were found to be positive predictors of RAO; higher heparin dosage was found to be a protective factor.<\/p>\n<p>When discussing the clinical implications of the study at TCT, Dr. Hammami stated: \u201cThe RIVARAD study showed the efficacy and safety of rivaroxaban in reducing the rate of RAO after TRA by 50%&#8230;this could be a good option to prevent RAO\u2026.however, interventional cardiologists must make more effort to respect preventative measures for this complication by implementing the guidelines of best practices of TRA.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Points: Radial artery occlusion (RAO) is the most common complication after radial access for coronary procedures; while routine intra-procedural heparin administration is a protective factor, the role of post-procedural anticoagulation has not been established. In the RIVARAD study, patients undergoing trans-radial access for coronary procedures were randomized to a week of post-procedural rivaroxaban vs [&hellip;]<\/p>\n","protected":false},"author":40603,"featured_media":131365,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[19,8,871],"tags":[47,873],"ppma_author":[1029],"class_list":{"0":"post-131364","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-interventional-cardiology","8":"category-news","9":"category-tct-2022","10":"tag-featured","11":"tag-tct-2022","12":"author-leah-kosyakovsky"},"authors":[{"term_id":1029,"user_id":40603,"is_guest":0,"slug":"leah-kosyakovsky","display_name":"Leah Kosyakovsky","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/864bde69f6f1f80e91e4a97f0a0ba8daa64c2bb702be09ed787444c7dfa045bb?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/131364","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40603"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=131364"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/131364\/revisions"}],"predecessor-version":[{"id":131366,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/131364\/revisions\/131366"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/131365"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=131364"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=131364"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=131364"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=131364"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}