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Direct thrombin inhibition appears to be a safe and effective anticoagulant for percutaneous bypass graft

John Kao1, A Michael Lincoff, Eric J Topol

  • 1Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 8, 2006
PubMed

Insights

Bivalirudin with provisional glycoprotein IIb/IIIa inhibition is safe and effective for coronary artery bypass graft percutaneous coronary interventions (CABG PCI). This direct thrombin inhibitor showed similar outcomes to heparin, with reduced minor bleeding events.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • Percutaneous coronary interventions (PCI) on coronary artery bypass grafts (CABG) have poorer outcomes than native coronary PCI.
  • Limited data exists on direct thrombin inhibitors during CABG PCI.
  • Investigating bivalirudin with glycoprotein IIb/IIIa (GPIIb/IIIa) blockade in CABG PCI is crucial.

Purpose of the Study:

  • To evaluate the safety and efficacy of bivalirudin with GPIIb/IIIa blockade in patients undergoing CABG PCI.
  • To compare bivalirudin-based strategies with heparin-based strategies in this patient population.

Main Methods:

  • Post hoc analysis of patients from the REPLACE-1 and REPLACE-2 trials undergoing CABG PCI.
  • Patients were randomized to heparin or bivalirudin, with GPIIb/IIIa inhibitor use varying (discretionary in REPLACE-1, provisional in REPLACE-2).
  • Outcomes assessed included death, myocardial infarction, urgent revascularization, major and minor bleeding, and 12-month mortality.

Main Results:

  • No significant differences in combined endpoints (death, MI, urgent revascularization, major bleeding) between bivalirudin and heparin groups.
  • Minor bleeding was significantly reduced with bivalirudin (14.8% vs. 22.7%, P=0.037).
  • At 12 months, similar efficacy was observed, with a trend towards decreased mortality in the bivalirudin group (4.2% vs. 7.8%, P=0.16).

Conclusions:

  • Bivalirudin with provisional GPIIb/IIIa inhibition demonstrates comparable safety and efficacy to heparin with GPIIb/IIIa inhibition in CABG PCI.
  • Bivalirudin offers a potential benefit of reduced minor bleeding in this setting.
  • These findings support the use of bivalirudin in CABG PCI procedures.
Abstract

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