Bivalirudin (Angiomax) use during intracoronary brachytherapy may predispose to acute closure.
We describe two cases of intracoronary vascular brachytherapy where bivalirudin (Angiomax), employed as an anticoagulant, led to abrupt vessel closure or threatened abrupt closure. Use of bivalirudin (Angiomax) during intracoronary brachytherapy may predispose to the formation of intracoronary thrombus, related to the reversible binding kinetics of the bivalirudin to thrombin, and resulting in recovery of thrombin functional activity during periods of prolonged stasis that occur during intracoronary brachytherapy. Intracoronary abciximab administration may be a useful strategy in resolving the acute closure, since abciximab administered early during the formation of thrombus has been shown to facilitate clot lysis.
Sharma
Sanjiv
S
Central Cardiology Medical Clinic, Bakersfield, CA 93301, USA.
Bhambi
Brijesh
B
Nyitray
William
W
Desai
Kirit
K
Davis
Dean L
DL
Sharma
Geetanjali
G
Shukla
Pankaj
P
File
Carla
C
Ishimori
Tetsuo
T
D000077284:Abciximab; D000208:Acute Disease; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001918:Brachytherapy; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D024764:Hirudin Therapy / Q000009:adverse effects*; D006629:Hirudins / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007267:Injections; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D013917:Thrombin / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D006629:Hirudins; D007140:Immunoglobulin Fab Fragments; D010446:Peptide Fragments; D011994:Recombinant Proteins; D013917:Thrombin; C074619:bivalirudin; D000077284:Abciximab