Abstract 219 Effectiveness of an intensified antithrombotic strategy for treatment of post-angiography radial artery occlusion


Effectiveness of an intensified antithrombotic strategy for treatment of post-angiography radial artery occlusion - first insights of the ProRadial study
J. Schlosser¹, L. Steffen¹, I. Younas¹, T. Böhme¹, K. Bürgelin¹, C. M. Valina¹, N. Löffelhardt¹, T. Nührenberg¹, F.-J. Neumann¹, W. Hochholzer¹
¹Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg / Bad Krozingen, Bad Krozingen;
Background: Current guidelines of the European Society of Cardiology recommend a radial-first strategy for patients undergoing coronary angiography. Previous data have suggested an incidence of radial artery occlusion following angiography in up to 20% of patients. Even if there is no evidence from large or randomized trials, treatment options for this vascular complication include low-molecular-weight heparin or oral anticoagulation for several weeks. The present study sought to investigate the incidence of radial artery occlusion post transradial coronary angiography in current practice and the effectiveness of oral anticoagulation to obtain vessel patency in patients with radial artery occlusion. Methods: Patients were enrolled in this study one day following transradial coronary angiography. All patients underwent a physical examination of the arm and doppler ultrasonography. In case of radial occlusion, which was defined as an absence of antegrade flow on doppler studies, patients underwent an oral anticoagulation regime. Antiplatelet treatment was guided by angiographic findings as recommended by current guidelines. All patients were scheduled for a 30-day follow-up including doppler ultrasonography. RESULTS: At the time of the interim analysis, 1049 patients were enrolled in this study (mean age 69±11 years; 64% male). A new radial occlusion was found in 4.7% of patients (49/1049). These patients were mainly treated with novel oral anticoagulants in therapeutic dose. Two patients did receive phenprocoumon. A compete follow-up was available from 39 patients (2 patients died during follow-up, 3 patients are lost to follow-up, 5 patients are still in the follow-up phase). Out of these 39 patients, 6 patients (15%) did show a patent radial artery and 33 (85%) a persistent radial occlusion. Conclusion: The present data demonstrate a limited effectiveness of oral anticoagulation for treatment of radial artery occlusion post transradial coronary angiography in clinical routine. Further randomized studies are needed to define the optimal treatment of this vascular complication.
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