PMID- 16598111
OWN - NLM
STAT- MEDLINE
DCOM- 20060620
LR  - 20161128
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 18
IP  - 3
DP  - 2006 Mar
TI  - Transitioning from heparin to bivalirudin in patients undergoing ad hoc 
      transradial interventional procedures: a pilot study.
PG  - 120-4
AB  - OBJECTIVE: The present study evaluated the combined use of unfractionated heparin 
      (UFH) and bivalirudin during ad hoc transradial interventional procedures. 
      BACKGROUND: 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. 
      METHODS: 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. RESULTS: 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. 
      CONCLUSIONS: 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.
FAU - Venkatesh, Kiran
AU  - Venkatesh K
AD  - Wake Heart Center, Raleigh, North Carolina, USA.
FAU - Mann, Tift
AU  - Mann T
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Aged
MH  - Anticoagulants/administration & dosage/*therapeutic use
MH  - Arterial Occlusive Diseases/epidemiology/*prevention & control
MH  - *Cardiac Catheterization/adverse effects
MH  - Chemotherapy, Adjuvant
MH  - Dose-Response Relationship, Drug
MH  - Drug Therapy, Combination
MH  - Female
MH  - Heparin/administration & dosage/*therapeutic use
MH  - Hirudins
MH  - Humans
MH  - Incidence
MH  - Inpatients/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/epidemiology/etiology
MH  - Peptide Fragments/*therapeutic use
MH  - Pilot Projects
MH  - Prospective Studies
MH  - *Radial Artery
MH  - Recombinant Proteins/therapeutic use
MH  - Whole Blood Coagulation Time
EDAT- 2006/04/07 09:00
MHDA- 2006/06/21 09:00
CRDT- 2006/04/07 09:00
PHST- 2006/04/07 09:00 [pubmed]
PHST- 2006/06/21 09:00 [medline]
PHST- 2006/04/07 09:00 [entrez]
PST - ppublish
SO  - J Invasive Cardiol. 2006 Mar;18(3):120-4.