Anticoagulation for Critically Ill Cardiac Surgery Patients: Is Primary Bivalirudin the Next Step?
| Autor: | N. Agracheva, Marina Pieri, Andreas Koster, Alberto Zangrillo, Remo Daniel Covello, Michele De Bonis, Maria Grazia Calabrò, Federico Pappalardo |
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| Přispěvatelé: | Pappalardo, Federico, Agracheva, N, Covello, Rd, Pieri, M, DE BONIS, Michele, Calabrò, Mg, Koster, A, Zangrillo, Alberto |
| Rok vydání: | 2014 |
| Předmět: |
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medicine.medical_specialty medicine.drug_class Critical Illness Antithrombins law.invention Postoperative Complications law Internal medicine Heparin-induced thrombocytopenia medicine Humans Bivalirudin Cardiac Surgical Procedures Propensity Score Retrospective Studies Dose-Response Relationship Drug business.industry Anticoagulant Thrombosis Odds ratio Hirudins Middle Aged medicine.disease Intensive care unit Peptide Fragments Recombinant Proteins Confidence interval Discontinuation Cardiac surgery Survival Rate Anesthesiology and Pain Medicine Italy Injections Intravenous Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 28:1013-1017 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2013.10.004 |
| Popis: | OBJECTIVE: Anticoagulation with unfractionated heparin (UFH) in critically ill cardiac surgery patients has several limitations, including the risk of heparin-induced thrombocytopenia. The use of a direct thrombin inhibitor, such as bivalirudin, might either treat this complication or completely eliminate it. The aim of the present study was to analyze the use of bivalirudin in this setting, as either a secondary drug switching from heparin or as the primary anticoagulant, and to evaluate clinical outcomes.DESIGN: Propensity-matching retrospective analysis.SETTING: A cardiac surgery intensive care unit.PARTICIPANTS: One hundred propensity-matched patients who received heparin or bivalirudin.INTERVENTIONS: Bivalirudin was administered as a first-line or second-line drug after heparin discontinuation in case of thrombocytopenia and suspicion of heparin-induced thrombocytopenia. Twenty-six patients (52%) received bivalirudin as a primary anticoagulant, while 24 patients (48%) received bivalirudin after switching from heparin.MEASUREMENTS AND MAIN RESULTS: Bivalirudin treatment was associated with a reduction of major bleeding (p = 0.05) compared with the control group. Interestingly, in an intention-to-treat analysis, patients receiving primary bivalirudin showed significant reductions in minor bleeding (p = 0.04), and mortality (p = 0.01) compared with the secondary bivalirudin group and, similarly, compared with the rest of the study population (UFH and secondary bivalirudin patients, p = 0.01 and p = 0.05, respectively). Predictors of hospital mortality by multivariate analysis included urgent admission (odds ratio [OR] = 2.7; 95 confidence interval [CI], 1.03-7.2; p = 0.04), ;septic shock (OR = 8.0; 95 CI, 2.26-28.7; p |
| Databáze: | OpenAIRE |
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