Post-procedural/pre-hemostasis intra-arterial nitroglycerin after transradial catheterization: A gender based analysis

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 500 μg 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 < 60 years as compared with women age ≥ 60 years [5.6% vs. 3.5%; odds ratio, 2.16; 95% CI, 1.18 to 3.94; P = 0.008]. In women age < 60 years (n = 237), both counter puncture technique and a duration of hemostasis ≥ 4 h 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 < 60 years was associated with a higher risk of RAO compared with age ≥ 60 years in women. Further strategies to reduce RAO in women are needed.