Transitioning from heparin to bivalirudin in patients undergoing ad hoc transradial interventional procedures: a...

The present study evaluated the combined use of unfractionated heparin (UFH) and bivalirudin during ad hoc transradial interventional procedures.

As a result of its proven efficacy in recent clinical trials, the direct thrombin inhibitor bivalirudin is now increasingly utilized as the anticoagulant of choice for coronary interventions. However, it is currently not packaged for diagnostic procedures. Patients undergoing ad hoc transradial procedures thus need unfractionated heparin during the diagnostic catheterization to protect against radial occlusion. It is unclear how the transition to bivalirudin should be undertaken if a subsequent intervention were performed.

A total of 117 patients underwent ad hoc transradial procedures. Fifty-one patients underwent diagnostic catheterizations receiving only 5,000 Units of UFH in divided doses: (1) Group 1H (n = 26), 2,500 U after sheath insertion and 2,500 U at conclusion; (2) Group 2H (n = 25), 1,000 U followed by 4,000 U. Sixty-six patients subsequently underwent interventions as part of the same procedure and received standard bivalirudin (B) dosing in addition to the initial UHF dose: Group 1B (n = 40), 2,500 Units of UFH plus B; Group 2B (n = 26), 1,000 Units of UFH plus B. The primary endpoint was postprocedure radial occlusion; secondary endpoints were any major adverse cardiac event (MACE) and any bleeding complication.

One patient (1%) had postprocedure radial occlusion, but this recanalized at 1 month. There were no deaths, and urgent target lesion revascularization was not required. Non-Q wave myocardial infarction occurred in 7.5%, all in Group 1B. No bleeding complications occurred.

The administration of bivalirudin after a reduced heparin dose in patients undergoing ad hoc transradial interventional procedures was not associated with adverse events in this small pilot study.