Bivalirudin as an anticoagulant for simultaneous integrated coronary artery revascularization - a novel approach to an inherent concern.
BACKGROUND
Simultaneous integrated coronary artery revascularization combines coronary artery bypass surgery and percutaneous coronary intervention into a single procedure. This approach provides immediate, complete and optimal myocardial revascularization in a less invasive manner. Because simultaneous integrated coronary revascularization necessitates two distinct anticoagulation protocols for the surgical and percutaneous aspects of the procedure, combining these anticoagulation protocols carries a bleeding risk. Using a single anticoagulant to facilitate the necessities of both aspects of the integrated approach may alleviate this risk.


METHODS
A 45-year-old man with an occluded left anterior descending artery and a moderately stenotic circumflex artery underwent simultaneous integrated coronary revascularization. Bivalirudin was used to achieve anticoagulation for the duration of the procedure. The patient was asymptomatic with excellent patency of both the bypass graft and the stented circumflex artery via angiography at 10 months.


CONCLUSIONS
Bivalirudin can be used to effectively achieve a unified anticoagulation protocol for simultaneous integrated revascularization.
McClure
R Scott
RS
Department of Surgery, Division of Cardiac Surgery, The University of Western Ontario, London Health Sciences Centre, University Hospital, London, Ontario N6A 5A5. scott.mcclure@lhsc.on.ca
Higgins
Jennifer
J
Swinamer
Stuart A
SA
Rayman
Reiza
R
Dobkowski
Wojciech B
WB
Kostuk
William J
WJ
Kiaii
Bob
B
D000925:Anticoagulants / Q000627:therapeutic use*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy*; D003331:Coronary Vessels; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D010446:Peptide Fragments / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin