title: Post-procedural/pre-hemostasis intra-arterial nitroglycerin after transradial catheterization: A gender based analysis.
abstract: BACKGROUND
  We analyzed the effect of nitroglycerin on radial artery occlusion (RAO) in women undergoing transradial catheterization.
  
  
  METHODS
  A total of 1706 patients undergoing transradial catheterization were randomized to receive either 500μg intra-arterial nitroglycerin or placebo at the end of the radial procedure. We explored the gender-based analysis between women (n=539) and men (n=1167). The primary outcome was the incidence of RAO as confirmed by absence of antegrade flow at one day after the transradial procedure evaluated by duplex ultrasound of the radial artery.
  
  
  RESULTS
  The use of nitroglycerin, as compared with placebo, did not significantly reduce the risk of RAO in women patients [odds ratio, 0.69; 95% confidence interval (CI), 0.38 to 1.26; P=0.147]. The risk of RAO was higher in women age <60years as compared with women age ≥60years [5.6% vs. 3.5%; odds ratio, 2.16; 95% CI, 1.18 to 3.94; P=0.008]. In women age <60years (n=237), both counter puncture technique and a duration of hemostasis ≥4h were associated with a similar enhanced risk of developing RAO (odds ratio, 3.51; 95% CI, 1.59 to 7.72; P<0.001).
  
  
  CONCLUSIONS
  The administration of nitroglycerin at the end of a transradial catheterization in women did not reduce the risk of RAO as determined by ultrasound one day after the radial procedure. Age <60years was associated with a higher risk of RAO compared with age ≥60years in women. Further strategies to reduce RAO in women are needed.
authors.affiliation: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors.forename: Surya
authors.initials: S
authors.lastname: Dharma
authors.affiliation: Department of Cardiology, Faculty of Medicine, University Clinic of Cardiology, University of St Cyril & Methodius, Vodnjanska 17, Skopje, Macedonia.
authors.forename: Sasko
authors.initials: S
authors.lastname: Kedev
authors.affiliation: Department of Cardiovascular Sciences, Apex Heart Institute, Ahmedabad, Gujarat, India.
authors.forename: Tejas
authors.initials: T
authors.lastname: Patel
authors.affiliation: Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
authors.forename: Renan
authors.initials: R
authors.lastname: Sukmawan
authors.affiliation: Penn State Heart and Vascular Institute Pennsylvania State University College of Medicine, Hershey, PA, USA.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Gilchrist
authors.affiliation: Duke University Medical Center Section Chief, Cardiology Durham VA Medical Center, Durham, NC, USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D001157:Arterial Occlusive Diseases / Q000517:prevention & control*; D006328:Cardiac Catheterization; D005260:Female; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000494:pharmacology*; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging*; D014665:Vasodilator Agents / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin
keywords: Nitroglycerin; Radial artery occlusion; Women