This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Sheikh, I. R. Articles by Bajwa, T. PubMed Articles by Sheikh, I. R. Articles by Bajwa, T.

Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention

A Single-Center Experience

Imran R. Sheikh, MD^_*, S. Hinan Ahmed, MD^_*, Naoyo Mori, PhD, Anjan Gupta, MD^_*, Mark Mewissen, MD^_*, Suhail Allaqaband, MD^_*, Tanvir Bajwa, MD^_*,_*

^_* Aurora Cardiovascular Services, Aurora Sinai/St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, Wisconsin
Center for Urban Population Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin

^_* Reprint requests and correspondence: Dr. Tanvir Bajwa, 2801 West Kinnickinnic River Parkway, #777, Milwaukee, Wisconsin 53215 (Email: bdanek{at}hrtcare.com).

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 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.

Key Words: bivalirudin • heparin • percutaneous peripheral intervention

Abbreviations and Acronyms   ACT = activated clotting time   GP = glycoprotein   PCI = percutaneous coronary intervention   PPI = percutaneous peripheral intervention   PRBC = packed red blood cells   UFH = unfractionated heparin