PMID- 17620676
OWN - NLM
STAT- MEDLINE
DCOM- 20070927
LR  - 20161124
IS  - 1557-2501 (Electronic)
IS  - 1042-3931 (Linking)
VI  - 19
IP  - 7
DP  - 2007 Jul
TI  - Interatrial septal defect closure for cerebrovascular accidents: exploring the 
      role of various anticoagulants.
PG  - 309-12
AB  - BACKGROUND: The role of different anticoagulants in reducing in-hospital 
      complications in patients undergoing closure of interatrial septal defects (IASD) 
      is unknown. In this study, we review our own experience with IASD closure data to 
      determine if in-hospital complications and ambulation time are influenced by the 
      use of various anticoagulants. METHODS: Fifty-five consecutive patients with a 
      history of unexplainable stroke or transient ischemic attacks (TIA), with the 
      exception of the presence of an IASD, were included in this study. Multiple 
      variables were collected including age, gender, history of smoking, hypertension, 
      diabetes, hypercholesterolemia, ejection fraction, anticoagulants used pre- and 
      postprocedure, anticoagulants used during the closure procedure, shunt grade 
      across the IASD pre- and postprocedure, defect size, and right-sided filling 
      pressures. Descriptive analysis was performed on all variables including 
      complications frequency and ambulation time, and compared between bivalirudin and 
      indirect thrombin inhibitors. RESULTS: Of 55 consecutive patients included in 
      this study, 22 patients received bivalirudin and 33 patients received 
      unfractionated heparin (UFH) (n = 26) or enoxaparin (n = 7). The bivalirudin 
      patients were older (60.1 vs 50.8 years; p = 0.028), with a higher incidence of 
      interatrial septal aneurysm (75% vs. 40.7%; p = 0.037). In-hospital complications 
      included 1 (5%) patient with a minor bleed (groin hematoma) in the bivalirudin 
      group, and 3 patients with minor bleed (1 GI bleed, 1 groin hematoma, and 1 
      transient ischemia on electrocardiogram) in the non-bivalirudin group (9.1%). No 
      patient had a major bleed that required a transfusion or prolonged hospital stay. 
      Ambulation time was not significantly different between the two groups (7.7 +/- 
      5.9 hours for bivalirudin and 6.9 +/- 5.1 hours for other anticoagulants; p = 
      NS). CONCLUSION: We conclude that bivalirudin is safe during IASD closure, with a 
      statistically nonsignificant trend toward fewer minor complications than UFH and 
      enoxaparin. No major bleeding occurred in either group. This could be due to the 
      fact that IASD closure is performed via venous access that generally carries a 
      low bleeding complication rate and allows safe early ambulation, irrespective of 
      the anticoagulant utilized and despite the use of 10 and 11 Fr sheaths. Given 
      that major differences do not appear to exist in this exploratory study between 
      the anticoagulants studied, patent foramen ovale closure is currently being 
      performed in our laboratory with UFH.
FAU - Shammas, Nicolas W
AU  - Shammas NW
AD  - Midwest Cardiovascular Research Foundation, Cardiovascular Medicine, Davenport, 
      IA 52803, USA. shammas@mchsi.com
FAU - Dippel, Eric J
AU  - Dippel EJ
FAU - Harb, Ghassan
AU  - Harb G
FAU - Egts, Stephanie
AU  - Egts S
FAU - Jerin, Michael
AU  - Jerin M
FAU - Stoakes, Penny
AU  - Stoakes P
FAU - Byrd, Jeannette
AU  - Byrd J
FAU - Shammas, Gail A
AU  - Shammas GA
FAU - Sharis, Peter
AU  - Sharis P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Invasive Cardiol
JT  - The Journal of invasive cardiology
JID - 8917477
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Enoxaparin)
RN  - 0 (Hirudins)
RN  - 0 (Peptide Fragments)
RN  - 0 (Recombinant Proteins)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Antithrombins
MH  - Cardiac Surgical Procedures/*methods
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Septal Defects, Atrial/complications/*therapy
MH  - Hirudins
MH  - Humans
MH  - Incidence
MH  - Intraoperative Complications/epidemiology/prevention & control
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/therapeutic use
MH  - Recombinant Proteins/therapeutic use
MH  - Retrospective Studies
MH  - Stroke/epidemiology/etiology/*prevention & control
MH  - Treatment Outcome
EDAT- 2007/07/11 09:00
MHDA- 2007/09/28 09:00
CRDT- 2007/07/11 09:00
PHST- 2007/07/11 09:00 [pubmed]
PHST- 2007/09/28 09:00 [medline]
PHST- 2007/07/11 09:00 [entrez]
PST - ppublish
SO  - J Invasive Cardiol. 2007 Jul;19(7):309-12.