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Bivalirudin in peripheral vascular interventions: a single center experience.
Nicolas W Shammas1, Jon H Lemke, Eric J Dippel
1Genesis Heart Institute, Cardiovascular Medicine, P.C., Davenport, Iowa, USA. shammas@mchsi.com
The Journal of Invasive Cardiology
|July 4, 2003
Summary
Bivalirudin, a direct thrombin inhibitor, shows feasibility and safety as an anticoagulant for peripheral angioplasty (PTA). This study found limited complications, suggesting a favorable alternative to unfractionated heparin in PTA procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Unfractionated heparin is standard for peripheral angioplasty (PTA).
- Bivalirudin offers predictable anticoagulation and inhibits thrombin without activating platelets.
- Clinical experience with bivalirudin in PTA is limited.
Purpose of the Study:
- To evaluate the feasibility and safety of bivalirudin as a primary anticoagulant during PTA.
- To compare complication rates of bivalirudin with historical data using unfractionated heparin.
Main Methods:
- A single-center prospective study involving 48 patients undergoing PTA.
- Patients received bivalirudin at a dose of 0.75 mg/kg bolus and 1.75 mg/kg/h infusion.
- Outcomes assessed included serious procedural complications, death, limb loss, and vascular complications.
Main Results:
- Only 4.2% of patients experienced major bleeding; no deaths, limb loss, or emergent revascularization occurred.
- Rates of death, limb loss, emergent revascularization, embolic strokes, and vascular complications were 0.0%.
- Complication rates compared favorably to historical data using unfractionated heparin (9.2%).
Conclusions:
- Bivalirudin appears to be a feasible and safe anticoagulant for PTA.
- Further large prospective studies are recommended to confirm these findings.