Bivalirudin as an anticoagulation agent: safety and efficacy in peripheral interventions.
OBJECTIVE
Traditionally, unfractionated heparin is used to prevent thrombotic complications in peripheral interventions. The purpose of this study is to evaluate the use of bivalirudin as the anticoagulant agent for peripheral interventions.


METHODS
A retrospective analysis of 108 patients who underwent 110 peripheral interventions between January 2002 and January 2004 and received bivalirudin as the sole anticoagulation agent was conducted at Baptist Cardiac and Vascular Institute. Interventions were performed in the following areas: iliac, femoropopliteal, and distal (n = 55), carotid (n = 31), vertebral (n = 1), renal (n = 14), aorta (n = 7), and subclavian (n = 2). The following procedural and clinical endpoints were examined: death, requirement of urgent surgery or surgery during the same admission, urgent percutaneous revascularization in the same treated vessel, thrombotic or embolic events, bleeding events, and groin complications.


RESULTS
A total of 266 lesions were dilated in 185 arteries. There were no procedural mortalities, procedural success was 99.1%, and the complication rate was 3.6%. There was one embolic stroke (0.9%), one thrombosis (0.9%), and two groin hematomas (1.8%). No patient required urgent surgery or reintervention in the same treated vessel. No complications were noted at 7 days after the procedure. There were two interventions by postprocedure day 30: toe amputation and groin debridement.


CONCLUSIONS
Bivalirudin is a safe alternative to unfractionated heparin as the anticoagulation agent in peripheral interventions. This study shows that the complication profile is comparable to other bivalirudin studies. Bivalirudin is effective, easy to use, and is associated with few bleeding complications.
Katzen
Barry T
BT
Department of Interventional Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, Florida 33176, USA. BarryK@baptisthealth.net
Ardid
Maria I
MI
MacLean
Alexandra A
AA
Kovacs
Margaret F
MF
Zemel
Gerald
G
Benenati
James F
JF
Powell
Alex
A
Samuels
Shaun
S
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001011:Aorta / Q000473:pathology* / Q000601:surgery*; D017536:Carotid Artery, Common / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000473:pathology* / Q000601:surgery*; D005431:Florida; D005500:Follow-Up Studies; D006629:Hirudins; D006801:Humans; D007083:Iliac Artery / Q000473:pathology* / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D011150:Popliteal Artery / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D012077:Renal Artery / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014711:Vertebral Artery / Q000473:pathology* / Q000601:surgery*
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin