Need for prophylactic application of verapamil in transradial coronary
procedures: a randomized trial. The VITRIOL (is Verapamil In TransRadial
Interventions OmittabLe?) trial.
Author(s): Hizoh I(1), Majoros Z, Major L, Gulyas Z, Szabo G, Kerecsen G, Korda A, Molnar F,
Kiss RG.
Affiliation(s): Author information:
(1)Department of Cardiology, Military Hospital, Budapest, Hungary.
Publication date & source: 2014, J Am Heart Assoc. , 3(2):e000588
BACKGROUND: Verapamil is traditionally applied prophylactically in transradial
procedures to prevent radial artery spasm. However, verapamil may have side
effects and is contraindicated in some clinical settings.
METHODS AND RESULTS: During an investigator-initiated, randomized, double-blind
trial, we evaluated the need for preventive verapamil administration. After
vascular access was established, patients received either 5 mg verapamil (n=297)
or placebo (n=294). We compared the rate of access site conversions as primary
end point using a superiority margin of 5%. Occurrence of code breaks (composite
of conversions and unplanned use of verapamil), overall verapamil use, procedural
and fluoroscopic times, contrast volume, and subjective pain were investigated as
secondary end points. The rate of access site conversions was not different in
the 2 arms (placebo 1.7% versus verapamil 0.7%, P=0.28, difference 1.0%, 95% CI
for the difference -1.1% to 3.3%). Proportion of code breaks was similar in the 2
groups (3.4% versus 1.3%, P=0.11), whereas overall verapamil use was markedly
lower in the placebo arm (2.0% versus 100%, P<0.0001). Procedural time (median
[IQR] 16.0 minutes [9.0 to 30.0 minutes] versus 17.0 minutes [10.0 to 31.0
minutes], P=0.37), fluoroscopic time (4.4 minutes [2.1 to 9.6 minutes] versus 4.8
minutes [2.4 to 10.7 minutes], P=0.28), contrast volume (72.5 mL [48.0 to 146.0
mL] versus 75.5 mL [47.0 to 156.5 mL], P=0.74), and pain score (P for trend=0.12)
were comparable in the 2 groups.
CONCLUSIONS: The preventive use of verapamil may be unnecessary for transradial
procedures. The omission of prophylactic verapamil may not only reduce the rate
of potential complications related to the drug but also allow the safe extension
of the transradial method to those with contraindications to verapamil.
CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique
identifier: NCT01402427.
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