PMID- 15282656
OWN - NLM
STAT- MEDLINE
DCOM- 20050131
LR  - 20171116
IS  - 0094-6176 (Print)
IS  - 0094-6176 (Linking)
VI  - 30
IP  - 3
DP  - 2004 Jun
TI  - Bivalirudin, blood loss, and graft patency in coronary artery bypass surgery.
PG  - 337-46
AB  - A safe and effective alternative is needed for patients in whom unfractionated 
      heparin (UFH) or protamine is contraindicated (e.g., those with heparin-induced 
      thrombocytopenia or allergy to protamine). Furthermore, choice of anticoagulant 
      may influence graft patency in coronary surgery and may therefore be important 
      even when there is no contraindication to UFH. Direct thrombin inhibitors have 
      several potential advantages over UFH, demonstrated in acute coronary syndromes. 
      However, there are also potential difficulties with their use related to lack of 
      reversal agents and paucity of clinical experience in monitoring their 
      anticoagulant activity at the levels required for cardiac surgery with 
      cardiopulmonary bypass (CPB). In the first prospective randomized trial of an 
      alternative to heparin in cardiac surgery, we compared bivalirudin (a 
      short-acting direct thrombin inhibitor) with UFH in 100 patients undergoing 
      off-pump coronary artery bypass (OPCAB) surgery. Blood loss for the 12 hours 
      following study drug initiation in the bivalirudin group was not significantly 
      greater than in the heparin group. Median graft flow was significantly higher in 
      the bivalirudin group. We concluded that anticoagulation for OPCAB surgery with 
      bivalirudin was feasible without a clinically important increase in perioperative 
      blood loss. A larger study is needed to investigate the impact of improved graft 
      patency on other clinical outcomes after cardiac surgery.
FAU - Merry, Alan F
AU  - Merry AF
AD  - University of Auckland and Green Lane Hospital, Auckland, New Zealand. 
      a.merry@auckland.ac.nz
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Anticoagulants)
RN  - 0 (Drug Combinations)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Protamines)
RN  - 0 (Recombinant Proteins)
RN  - 24967-94-0 (Dermatan Sulfate)
RN  - 9005-49-6 (Heparin)
RN  - 9007-28-7 (Chondroitin Sulfates)
RN  - 9050-30-0 (Heparitin Sulfate)
RN  - BI6GY4U9CW (danaparoid)
RN  - EC 3.4.21.- (Ancrod)
RN  - EC 3.4.21.5 (Thrombin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Ancrod/therapeutic use
MH  - Angiography
MH  - Anticoagulants/*therapeutic use
MH  - Chondroitin Sulfates/therapeutic use
MH  - Coronary Artery Bypass/*methods
MH  - Dermatan Sulfate/therapeutic use
MH  - Drug Combinations
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Heparitin Sulfate/therapeutic use
MH  - Hirudins/*analogs & derivatives
MH  - Humans
MH  - Peptide Fragments/*therapeutic use
MH  - Prospective Studies
MH  - Protamines/therapeutic use
MH  - Recombinant Proteins/*therapeutic use
MH  - Regional Blood Flow
MH  - Syndrome
MH  - Thrombin/antagonists & inhibitors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2004/07/30 05:00
MHDA- 2005/02/03 09:00
CRDT- 2004/07/30 05:00
PHST- 2004/07/30 05:00 [pubmed]
PHST- 2005/02/03 09:00 [medline]
PHST- 2004/07/30 05:00 [entrez]
AID - 10.1055/s-2004-831046 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2004 Jun;30(3):337-46. doi: 10.1055/s-2004-831046.