Rivaroxaban cuts radial artery occlusion rates

Rivaroxaban reduces radial artery occlusion rate, without significantly increasing bleeds, in patients undergoing transradial coronary procedures in the RIVARAD study.

At 30 days following the procedures, occlusion rate by ultrasound was lower with rivaroxaban at 6.9 percent vs 13 percent with controls (odds ratio [OR], 0.50, 95 percent confidence interval [CI], 0.27–0.91; p=0.011), reported investigator Dr Rania Hammami from Hedi Chaker Hospital, Sfax, Tunisia at TCT 2022.

“Our study may change practice, especially in patients who are at high risk for radial artery occlusion,” she told an audience of interventional cardiologists.

The Bleeding Academic Research Consortium (BARC)-defined haemorrhagic events were numerically higher with rivaroxaban, but the difference was not statistically significant (2.7 percent vs 1.9 percent; OR, 1.4, 95 percent CI, 0.4–4.5).

Radial artery occlusion is the most common complication of transradial access, affecting 0.8 percent to 33 percent of cases, according to Hammami. Occlusion precludes the use of the artery for future coronary procedures, as a conduit for CABG, or a fistula for haemodialysis.

Occlusion rates with vs without rivaroxaban

The researchers sought to evaluate if a prophylactic dose of rivaroxaban could mitigate occlusion in 538 patients (mean age 60 years, 32 percent women) undergoing coronary angiography and or percutaneous coronary intervention (PCI). Patients were randomly assigned to rivaroxaban 10 mg or standard of care (without rivaroxaban) for 7 days after the procedure.

Over 60 percent of the patients had non–ST-elevation acute coronary syndrome (NSTE-ACS), 24.5 percent had chronic coronary syndrome, and 9.6 percent had STEMI. The rest had other indications for catheterization.

Thirty-five percent of the patients underwent PCI and were given nitroglycerin, nicardipine, and unfractionated heparin. Forty-one percent were treated with aspirin; 47 percent received dual antiplatelet therapy with clopidogrel and aspirin following the procedure.

Manual band compression was applied at the puncture site. Haemostasis was achieved in 67 percent of the patients after >6 hours.

Overall, one in 10 patients developed radial artery occlusion. Patients in the rivaroxaban group were less likely to have a nonpalpable radial artery pulse at 30 days (5.8 percent vs 12.2 percent; p=0.01). With regard to bleeding, 2.3 percent of patients experienced minor (BARC 1) bleeding, with no severe haemorrhagic complications. There was none reported in patients treated with rivaroxaban alone, there were four in patients on DAPT + rivaroxaban, three in those taking aspirin + rivaroxaban, three in those taking DAPT, and two in those taking aspirin.

Female sex, current smoking status, and prior transradial procedures were all found to be positive predictors of radial artery occlusion; higher heparin dosage was found to be a protective factor.

Commenting on the study, Dr Roxana Mehran from Icahn School of Medicine, Mount Sinai, New York, US  said preserving the artery for future use is incredibly important. As for rivaroxaban, she said more studies are needed to ascertain its role in preventing radial artery occlusion.

Numerous ongoing trials, including the CAPITAL-RAPTOR study, are currently evaluating the effect of higher dose rivaroxaban following transradial access for the prevention of radial artery occlusion. Complete results are expected in August next year. [NCT03630055, accessed October 17, 2022]