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Ann Thorac Surg 2007;84:836-839
© 2007 The Society of Thoracic Surgeons
a Department of Cardiovascular and Thoracic Surgery, Gaston Memorial Hospital, Gastonia, North Carolina
b Department of Cardiac Surgery, Washington State University, Seattle, Washington
c Department of Anesthesia, Deutsches Herzzentrum Berlin, Berlin, Germany
d Department of Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
e Department of Cardiac Anesthesia, Massachusetts General Hospital, Boston, Massachusetts
f Department of Anesthesia, Duke University Medical Center, Durham, North Carolina
g Department of Cardiac Surgery and Cardiothoracic Anesthesia, Virginia Commonwealth University, Richmond, Virginia
h Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Accepted for publication April 2, 2007.
* Address correspondence to Dr Dyke, Gaston Memorial Hospital, 2555 Court Drive, Suite 200, Gastonia, NC 28054 (Email: dykec{at}gmh.org).
Background: This study assessed the use of bivalirudin as an alternative anticoagulant in patients with heparin-induced thrombocytopenia-thrombotic syndrome (HIT/TS) or antiplatelet factor four-heparin (anti-PF4/H) antibodies undergoing off-pump coronary artery bypass (OPCAB).
Methods: In a prospective, open-label, multicenter study, fifty-one patients with documented anti-PF4/H antibodies and (or) HIT/TS underwent OPCAB with bivalirudin anticoagulation (0.75 mg/kg IV bolus, 1.75 mg/kg/hour infusion). Procedural success (absence of death, Q-wave myocardial infarction, repeat revascularization, and stroke), bleeding, and transfusion at day seven/discharge, thirty days, and twelve weeks were assessed.
Results: Thirty-five patients (67%) were included with positive anti-PF4/H antibodies and no thrombocytopenia or thrombosis, eleven patients (22%) had thrombocytopenia, and five patients had clinical HIT/TS (10%). Procedural success at seven days/discharge was achieved in forty-seven patients (92%), while procedural success at thirty days and twelve weeks was 88%. There were no deaths. Chest tube output over the first twenty-four hours was 936 ± 525 mL and twenty-five patients received a red blood cell transfusion during their hospitalization. Two patients required reexploration for persistent postoperative hemorrhage.
Conclusions: Bivalirudin was an effective alternative anticoagulant for patients with HIT/TS or circulating anti-PF4/H antibodies undergoing OPCAB, with high rates of procedural success and an acceptable incidence of bleeding or transfusions.
This article has been cited by other articles:
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  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]
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 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]
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 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]
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 A. F. Merry Invited commentary Ann. Thorac. Surg., September 1, 2007; 84(3): 840 - 840. [Full Text] [PDF]
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