PMID- 19778776
OWN - NLM
STAT- MEDLINE
DCOM- 20091203
LR  - 20220408
IS  - 1876-7605 (Electronic)
IS  - 1936-8798 (Linking)
VI  - 2
IP  - 9
DP  - 2009 Sep
TI  - Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in 
      percutaneous peripheral intervention: a single-center experience.
PG  - 871-6
LID - 10.1016/j.jcin.2009.06.015 [doi]
AB  - OBJECTIVES: The aim of this study was to determine the efficacy and safety of 
      bivalirudin versus low-dose unfractionated heparin (UFH) in percutaneous 
      peripheral intervention (PPI). BACKGROUND: Anticoagulation strategies used in PPI 
      are based primarily on studies of percutaneous coronary intervention where higher 
      doses of heparin are used usually in combination with a glycoprotein IIb/IIIa 
      inhibitor. There are no studies comparing bivalirudin alone versus low-dose 
      heparin in PPI. METHODS: Consecutive patients who underwent PPI at our 
      institution were treated with either bivalirudin or low-dose UFH. Patients were 
      assessed prospectively during index hospital stay for procedural success and 
      bleeding complications. Of 236 patients, 111 were dosed with UFH at 50 U/kg (goal 
      activated clotting time of 180 to 240 s), and 125 were dosed with bivalirudin at 
      0.75-mg/kg/h bolus followed by a 1.75-mg/kg infusion. Procedural success was 
      defined as <20% post-procedure residual stenosis with no flow-limiting 
      dissections or intravascular thrombus formation and major bleeding as 
      intracranial or retroperitoneal hemorrhage or a fall in hemoglobin >or=5 g/dl. 
      Anticoagulation cost analysis was conducted. RESULTS: Procedural success and 
      major bleeding rates were similar with bivalirudin versus heparin (98% vs. 99% 
      and 2.4% vs. 0.9%, respectively). There were no differences in minor bleeding, 
      time to ambulation, and length of hospital stay. The hospital cost for 
      bivalirudin was $547 and <$1.22 for heparin (10,000 U). Two activated clotting 
      time levels cost $4.00. CONCLUSIONS: Low-dose UFH is as effective and safe as 
      bivalirudin when used as an anticoagulation strategy in patients undergoing PPI, 
      and low-dose UFH is less costly than bivalirudin. Larger randomized studies are 
      required to further evaluate these findings.
FAU - Sheikh, Imran R
AU  - Sheikh IR
AD  - Aurora Cardiovascular Services, Aurora Sinai/St Luke's Medical Centers, 
      University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical 
      Campus, Milwaukee, Wisconsin, USA.
FAU - Ahmed, S Hinan
AU  - Ahmed SH
FAU - Mori, Naoyo
AU  - Mori N
FAU - Gupta, Anjan
AU  - Gupta A
FAU - Mewissen, Mark
AU  - Mewissen M
FAU - Allaqaband, Suhail
AU  - Allaqaband S
FAU - Bajwa, Tanvir
AU  - Bajwa T
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - JACC Cardiovasc Interv
JT  - JACC. Cardiovascular interventions
JID - 101467004
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  - Aged, 80 and over
MH  - *Angioplasty/adverse effects/economics/instrumentation
MH  - Anticoagulants/adverse effects/economics/*therapeutic use
MH  - Cost-Benefit Analysis
MH  - Drug Costs
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/economics/*therapeutic use
MH  - Hirudins/adverse effects/economics
MH  - Hospital Costs
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Peptide Fragments/adverse effects/economics/*therapeutic use
MH  - Peripheral Vascular Diseases/drug therapy/economics/*therapy
MH  - Prospective Studies
MH  - Recombinant Proteins/adverse effects/economics/therapeutic use
MH  - Stents
MH  - Thrombosis/etiology/prevention & control
MH  - Time Factors
MH  - Treatment Outcome
MH  - Walking
EDAT- 2009/09/26 06:00
MHDA- 2009/12/16 06:00
CRDT- 2009/09/26 06:00
PHST- 2009/04/21 00:00 [received]
PHST- 2009/06/16 00:00 [revised]
PHST- 2009/06/25 00:00 [accepted]
PHST- 2009/09/26 06:00 [entrez]
PHST- 2009/09/26 06:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - S1936-8798(09)00473-7 [pii]
AID - 10.1016/j.jcin.2009.06.015 [doi]
PST - ppublish
SO  - JACC Cardiovasc Interv. 2009 Sep;2(9):871-6. doi: 10.1016/j.jcin.2009.06.015.