title: Need for prophylactic application of verapamil in transradial coronary procedures: a randomized trial. The VITRIOL (is Verapamil In TransRadial Interventions OmittabLe?) trial.
abstract: 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.
  
  
  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.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01402427.
authors.affiliation: Department of Cardiology, Military Hospital, Budapest, Hungary.
authors.forename: Istvan
authors.initials: I
authors.lastname: Hizoh
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Majoros
authors.forename: Laszlo
authors.initials: L
authors.lastname: Major
authors.forename: Zalan
authors.initials: Z
authors.lastname: Gulyas
authors.forename: Gabor
authors.initials: G
authors.lastname: Szabo
authors.forename: Gabor
authors.initials: G
authors.lastname: Kerecsen
authors.forename: Andras
authors.initials: A
authors.lastname: Korda
authors.forename: Ferenc
authors.initials: F
authors.lastname: Molnar
authors.forename: Robert Gabor
authors.initials: RG
authors.lastname: Kiss
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014661:Vasoconstriction / Q000187:drug effects*; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014700:Verapamil / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D002121:Calcium Channel Blockers; D014665:Vasodilator Agents; D014700:Verapamil
keywords: coronary angiography; drug policy; percutaneous coronary intervention; transradial; vasodilator; verapamil
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