Bivalirudin compared with IIb/IIIa inhibitors in patients with in-stent restenosis undergoing intracoronary brachytherapy

Pramod Kuchulakanti, Roswitha Wolfram, Rebecca Torguson, Seung Woon Rha, Edouard Cheneau, Leonardo Clavijo, William W. Chu, Ellen E. Pinnow, Daniel Canos, Lowell F. Satler, William O. Suddath, Augusto D. Pichard, Kenneth M. Kent, Ron Waksman

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6 Citations (Scopus)

Abstract

Background: Bivalirudin is replacing heparin in percutaneous coronary interventions (PCIs), including vascular brachytherapy (VBT). The aim of the study was to compare bivalirudin with eptifibatide in patients with in-stent restenosis (ISR) undergoing PCI and VBT. Methods: One hundred forty-four patients treated with bivalirudin as a single antithrombotic agent were compared with 150 patients treated with eptifibatide. Bivalirudin as a bolus of 0.75 mg/kg followed by 1.75 mg/kg/h infusion until the end of the procedure, and eptifibatide as a double bolus of 180 μg/kg followed by 2 μg/kg/min infusion for 18 h after the procedure were used. The main outcome measures were in-hospital events and 30-day clinical outcomes. Results: Baseline clinical characteristics were similar except that patients in the eptifibatide group were younger (P=.02) and had more saphenous vein graft lesions (P<.001). Patients in the bivalirudin group had a higher number of lesions in the right coronary artery (P<.001) and a higher number of vessels treated (P<.001). Postprocedure creatinine phosphokinase (CPK)-MB levels were significantly lower in the bivalirudin group (P<.03). In-hospital events showed significantly less minor bleeding (P=.01) and a trend toward lower major bleeding and major adverse cardiac events (MACE) in the bivalirudin group (P=.06). Thirty-day outcomes showed a significantly lower incidence of non-Q-wave myocardial infarction (MI) in the bivalirudin group (P=.004). Conclusion: Bivalirudin, as a single antithrombotic agent during PCI and VBT, is associated with significantly lower postprocedural CPK-MB elevation, minor bleeding complications, 30-day non-Q-wave MI rates, and a trend toward lower major bleeding and in-hospital MACE when compared with eptifibatide.

Original languageEnglish
Pages (from-to)154-159
Number of pages6
JournalCardiovascular Revascularization Medicine
Volume6
Issue number4
DOIs
Publication statusPublished - 2005 Oct 1

Keywords

  • Bivalirudin
  • Brachytherapy
  • In-stent Restenosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Kuchulakanti, P., Wolfram, R., Torguson, R., Rha, S. W., Cheneau, E., Clavijo, L., Chu, W. W., Pinnow, E. E., Canos, D., Satler, L. F., Suddath, W. O., Pichard, A. D., Kent, K. M., & Waksman, R. (2005). Bivalirudin compared with IIb/IIIa inhibitors in patients with in-stent restenosis undergoing intracoronary brachytherapy. Cardiovascular Revascularization Medicine, 6(4), 154-159. https://doi.org/10.1016/j.carrev.2005.06.003