| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2004;77:925-931
© 2004 The Society of Thoracic Surgeons
a University of Auckland, Auckland, New Zealand
b Department of Anesthesiology, Green Lane Hospital, Auckland, New Zealand
c Department of Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand
d Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
e Department of Medicine, University of Otago, Dunedin, New Zealand
Accepted for publication September 8, 2003.
* Address reprint requests to Dr Merry, Department of Anaesthesiology, University of Auckland, Mercy Hospital, 98 Mountain Rd, Private Bag 92019, Auckland 1003, New Zealand
e-mail: a.merry{at}auckland.ac.nz
BACKGROUND: Bivalirudin is a short-acting direct thrombin inhibitor, with advantages over unfractionated heparin for anticoagulation in cardiac surgery. We hypothesized that bivalirudin is not associated with a clinically important increase in blood loss compared with heparin with protamine reversal in patients undergoing off pump coronary artery bypass (OPCAB) surgery. We also assessed flow with angiography at 3 months using a modified Thombolysis in Myocardial Infarction (TIMI) grade in the grafted coronary arteries.
METHODS: One hundred patients were randomly assigned to receive bivalirudin (0.75 mg/kg bolus, 1.75 mg/kg/h infusion) or heparin (150 to 300 U/kg bolus) with protamine reversal.
RESULTS: A median of 3 (range, 1 to 5) grafts were inserted per patient. Blood loss for the 12 hours after study drug initiation in the bivalirudin group (median, 793 mL; interquartile range, 532 to 1,214 mL; range, 320 to 4,909 mL; n = 50) was not significantly greater than in the heparin group (median, 805 mL; interquartile range, 517 to 1,117 mL; range, 201 to 2,567 mL; n = 50; p = 0.165). Median graft flow was 3.0 in the bivalirudin group (n = 40) and 2.67 in the heparin group (n = 39; p = 0.047). The bivalirudin group had more patients with grade 3 (ie, full) flow in at least 1 graft (100% versus 90%; p = 0.04), a trend toward more patients with grade 3 flow in all grafts (60% versus 38%; p = 0.06), and more grafts with grade 3 flow (82% versus 67%; p = 0.03).
CONCLUSIONS: Anticoagulation for OPCAB surgery with bivalirudin was feasible without a clinically important increase in perioperative blood loss. Graft flow was better in the bivalirudin patients; the impact of this on clinical outcomes requires a larger study.
This article has been cited by other articles:
|
|
 |
|
  L. Shore-Lesserson Invited Commentary Ann. Thorac. Surg., February 1, 2010; 89(2): 427 - 428. [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Avery, A. D. Hilgenberg, R. P. Cambria, R. Beckerly, A. M. Donnelly, and M. Laposata Successful Use of Bivalirudin for Combined Carotid Endarterectomy and Coronary Revascularization with the Use of Cardiopulmonary Bypass in a Patient with an Elevated Heparin-Platelet Factor 4 Antibody Titer Anesth. Analg., April 1, 2009; 108(4): 1113 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A Koster, S Buz, T Krabatsch, R Yeter, and R Hetzer Bivalirudin anticoagulation during cardiac surgery: a single-center experience in 141 patients Perfusion, January 1, 2009; 24(1): 7 - 11. [Abstract] [PDF]
|
|
|
|
 |
|
 B. Kiaii, R. S. McClure, P. Stewart, R. Rayman, S. A. Swinamer, Y. Suematsu, S. Fox, J. Higgins, C. Albion, W. J. Kostuk, et al. Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 702 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Q. A Czosnowski, S. W Finks, and K. C Rogers Bivalirudin for Patients with Heparin-Induced Thrombocytopenia Undergoing Cardiovascular Surgery Ann. Pharmacother., September 1, 2008; 42(9): 1304 - 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. E. Warkentin, A. Greinacher, A. Koster, and A. M. Lincoff Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 340S - 380S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Becker Emerging constructs to maintain safety among patients with acute coronary syndromes requiring surgical coronary revascularization Eur. Heart J. Suppl., May 1, 2008; 10(suppl_D): D12 - D22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Levy, K. A. Tanaka, and J. M. Bailey Cardiac Surgical Pharmacology Card. Surg. Adult, January 1, 2008; 3(2008): 77 - 110. [Full Text]
|
|
|
|
 |
|
 A. F. Merry Focus on Thrombin: Alternative Anticoagulants Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2007; 11(4): 256 - 260. [Abstract] [PDF]
|
|
|
|
|
|
K. A. Tanaka, F. Szlam, H. Y. Sun, T. Taketomi, and J. H. Levy Thrombin Generation Assay and Viscoelastic Coagulation Monitors Demonstrate Differences in the Mode of Thrombin Inhibition Between Unfractionated Heparin and Bivalirudin Anesth. Analg., October 1, 2007; 105(4): 933 - 939. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Dyke, G. Aldea, A. Koster, N. Smedira, E. Avery, S. Aronson, B. D. Spiess, and A. M. Lincoff Off-Pump Coronary Artery Bypass With Bivalirudin for Patients With Heparin-Induced Thrombocytopenia or Antiplatelet Factor Four/Heparin Antibodies Ann. Thorac. Surg., September 1, 2007; 84(3): 836 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Koster, B. Spiess, M. Jurmann, C. M. Dyke, N. G. Smedira, S. Aronson, and M. A. Lincoff Bivalirudin Provides Rapid, Effective, and Reliable Anticoagulation During Off-Pump Coronary Revascularization: Results of the "EVOLUTION OFF" Trial. Anesth. Analg., September 1, 2006; 103(3): 540 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Cain, B. D. Spiess, M. Nelson, A. Deanda Jr, H. L. McCarthy, and J. A. Green Bivalirudin Anticoagulation for a Patient with Hypercoagulable Immune Syndromes Undergoing Mitral Valve Surgery Ann. Thorac. Surg., June 1, 2006; 81(6): 2308 - 2310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Anticoagulation for cardiopulmonary bypass: is a replacement for heparin on the horizon? J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 515 - 516.
|
|
|
|
|
|
C. M. Dyke, N. G. Smedira, A. Koster, S. Aronson, H. L. McCarthy II, R. Kirshner, A. M. Lincoff, and B. D. Spiess A comparison of bivalirudin to heparin with protamine reversal in patients undergoing cardiac surgery with cardiopulmonary bypass: The EVOLUTION-ON study J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 533 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. G. Smedira, C. M. Dyke, A. Koster, M. Jurmann, D. S. Bhatia, T. Hu, H. L. McCarthy II, A. M. Lincoff, B. D. Spiess, and S. Aronson Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: The results of the EVOLUTION-OFF study J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 686 - 692. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Poston, J. Gu, J. M. Brown, J. S. Gammie, C. White, L. Nie, R. N. Pierson III, and B. P. Griffith Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 122 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Di Nisio, S. Middeldorp, and H. R. Buller Direct Thrombin Inhibitors N. Engl. J. Med., September 8, 2005; 353(10): 1028 - 1040. [Full Text] [PDF]
|
|
|
|
|
|
C. M. Dyke, A. Koster, J. J. Veale, G. W. Maier, T. McNiff, and J. H. Levy Preemptive Use of Bivalirudin for Urgent On-Pump Coronary Artery Bypass Grafting in Patients With Potential Heparin-Induced Thrombocytopenia Ann. Thorac. Surg., July 1, 2005; 80(1): 299 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Koster, R. Yeter, S. Buz, H. Kuppe, R. Hetzer, A. M. Lincoff, C. M. Dyke, N. G. Smedira, and B. Spiess Assessment of hemostatic activation during cardiopulmonary bypass for coronary artery bypass grafting with bivalirudin: Results of a pilot study J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1391 - 1394. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Hallman, L. Hebbar, J. Robison, and W. E. Uber The Use of Argatroban for Carotid Endarterectomy in Heparin-Induced Thrombocytopenia Anesth. Analg., April 1, 2005; 100(4): 946 - 948. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Boning, T. Morschheuser, U. Blase, J. Scheewe, M. von der Brelie, R. Grabitz, and J. T. Cremer Incidence of Heparin-Induced Thrombocytopenia and Therapeutic Strategies in Pediatric Cardiac Surgery Ann. Thorac. Surg., January 1, 2005; 79(1): 62 - 65. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Gurbuz, W. G. Elliott, and A. A. Zia Heparin-induced thrombocytopenia in the cardiovascular patient: diagnostic and treatment guidelines Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 138 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. E. Warkentin and A. Greinacher Heparin-Induced Thrombocytopenia: Recognition, Treatment, and Prevention: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 311S - 337S. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
