Is magnesium sulfate efficacious as classic cocktails for the prevention of radial vasospasm and is it interesting in hemodynamically impaired patient?

1. Is magnesium sulfate efficacious as classic cocktails for the
prevention of radial vasospasm and is it interesting in
hemodynamically impaired patient ?
N HAJLAOUI, N BEN MANSOUR, B JEDAIDA, A HAGGUI, D LAHIDHEB, T FILALI, W
FEHRI, H HAOUALA
Cardiology department of the Military Hospital of Tunis

2. Disclosure : Hajlaoui N , M.D
• Dr <Hajlaoui N>has no relevant financial
interests to disclose

3. INTRODUCTION
• Radial access reduces bleeding and vascular
complications.
•
Different vasodilating cocktails are used to
prevent vasospasm.
• The most widespread used ones associates
nitroglycerine and a calcium channel inhibitor.
• Little studies demonstrate the superiority of
magnesium sulfate for RV prevention.

4. OBJECTIVE
• To compare a cocktail regimen of magnesium
sulfate (150mg) + Heparin (50mg) (C1) to a
cocktail of Nitroglycerin (1mg) + Nicardipine
(1mg) + Heparin (50mg) (C2) for the
effectiveness to prevent RV.

5. METHODS
• Prospective randomised single blinded trial
including
patients
undergoing
radial
coronarography performed by advanced
training operators.
• Radial vasospasm was defined by visual
analogic scale>5 or manipulation difficulties
reported by the operators.

6. RESULTS
• 70 patients included
• 35 received C1 and 35 received C2.
• 4 patients excluded (1 for impossibility of left
main canulation, 1 for extreme arterial
tortuosity, 1 for subclavian artery occlusion and
1 for anaphylactic choc).
• 66 patients analyzed.

7. RESULTS
• Baseline demographic characteristics were
similar between C1 and C2 groups.
• No significant difference between groups for
procedure duration, quantity of sedative
drugs received, type of sheath used, attempts
of radial puncture, number of catheter used ,
quantity of nitroglycerin administrated during
procedure and radiation exposure.

8. RESULTS
• RV in 23% of procedures (n=15).
• 10/34 patient in C1 group presented RV versus 5/32 in C2
group the (p=0,13).
• Conversion to femoral approach in 3 cases, all in C2 group.
• Mean SBP was not significantly different between two
groups before cocktail administration (160mmHg vs.
159mmHg), after cocktail administration, the mean SBP was
significantly lower in the C2 group (151mmHg vs. 129mmHg)
(p=0, 01).
• 2 patients from C2 group presented during the procedure
severe hypotension necessitating administration of
macromolecular solutes versus any patient in C1 group, the
difference is not statistically significant.

9. DISCUSSION
• There is no significant difference between the
compared cocktails for the prevention of RV
• Although the difference is not significant,
magnesium sulfate seems to cause less
hemodynamic impairment
• Magnesium sulfate may be the right cocktail for
patient at high risk of severe hypotension with
nitroglycerine and calcium channel inhibitor
cocktail.

10. Magnesium sulfate during transradial cardiac
catheterization: a new use for an old drug?
• Prospective, double-blind, randomized trial of 86 patients
undergoing radial catheterization.
•
Magnesium sulfate (150 mg) Vs verapamil (1 mg)
• Following administration of the study drug, there was an increase
in radial artery diameter in both groups (p < 0.01), although the
increase
seen
was
greater
in
the
group
receiving magnesium (magnesium 0.36 +/- 0.03 mm; verapamil 0.27
+/- 0.03 mm; p < 0.05). Administration of verapamil resulted in a
fall in mean arterial pressure (MAP) (change in MAP -6.6 +/- 1.4
mmHg; p < 0.01), whereas magnesium did not have a hemodynamic
effect.

11. CONCLUSION
• Trend to less hemodynamic impairment with
Magnesium sulfate
• Study underpowerd to demonstrate
significant difference
• Larger studies are needed