Bivalirudin versus heparin and protamine in off-pump coronary artery bypass surgery
| Autor: | Harvey D. White, Brigid P. Mills, John M McDougall, Parma Nand, Chris Frampton, Neil G. Middleton, Bruce Webber, Alan Merry, Peter J Raudkivi |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.medical_treatment Blood Loss Surgical Antithrombins Bolus (medicine) Interquartile range Internal medicine medicine Bivalirudin Humans Myocardial infarction Protamines Coronary Artery Bypass Off-pump coronary artery bypass Aged business.industry Heparin Anticoagulants Heparin Antagonists Hirudins Middle Aged medicine.disease Peptide Fragments Recombinant Proteins Surgery Treatment Outcome Direct thrombin inhibitor Anesthesia Cardiology Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business TIMI medicine.drug |
| Zdroj: | The Annals of thoracic surgery. 77(3) |
| ISSN: | 0003-4975 |
| Popis: | Background Bivalirudin is a short-acting direct thrombin inhibitor, with advantages over unfractionated heparin for anticoagulation in cardiac surgery. We hypothesized that bivalirudin is not associated with a clinically important increase in blood loss compared with heparin with protamine reversal in patients undergoing off pump coronary artery bypass (OPCAB) surgery. We also assessed flow with angiography at 3 months using a modified Thombolysis in Myocardial Infarction (TIMI) grade in the grafted coronary arteries. Methods One hundred patients were randomly assigned to receive bivalirudin (0.75 mg/kg bolus, 1.75 mg/kg/h infusion) or heparin (150 to 300 U/kg bolus) with protamine reversal. Results A median of 3 (range, 1 to 5) grafts were inserted per patient. Blood loss for the 12 hours after study drug initiation in the bivalirudin group (median, 793 mL; interquartile range, 532 to 1,214 mL; range, 320 to 4,909 mL; n=50) was not significantly greater than in the heparin group (median, 805 mL; interquartile range, 517 to 1,117 mL; range, 201 to 2,567 mL; n=50; p = 0.165). Median graft flow was 3.0 in the bivalirudin group (n = 40) and 2.67 in the heparin group (n = 39; p = 0.047). The bivalirudin group had more patients with grade 3 (ie, full) flow in at least 1 graft (100% versus 90%; p = 0.04), a trend toward more patients with grade 3 flow in all grafts (60% versus 38%; p = 0.06), and more grafts with grade 3 flow (82% versus 67%; p = 0.03). Conclusions Anticoagulation for OPCAB surgery with bivalirudin was feasible without a clinically important increase in perioperative blood loss. Graft flow was better in the bivalirudin patients; the impact of this on clinical outcomes requires a larger study. |
| Databáze: | OpenAIRE |
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