Comparison of bivalirudin versus heparin on radial artery occlusion after transradial catheterization.
BACKGROUND
Anticoagulant therapy is required to prevent radial artery occlusion (RAO) after transradial catheterization. There is no data comparing bivalirudin to standard heparin.


METHODS
We studied 400 consecutive patients. In case of diagnostic angiography-only (n = 200), they received an intravenous bolus of heparin (70 U kg(-1)) immediately before sheath removal whereas in case of angiography followed by ad hoc percutaneous coronary intervention (n = 200), they received bivalirudin (bolus 0.75 mg kg(-1), followed by infusion at 1.75 mg/kg/h). RAO was assessed 4-8 weeks later using two-dimensional echography-doppler and reverse Allen's test with pulse oximetry.


RESULTS
At follow-up, 21 of the 400 (5.3%) patients were found to have RAO with no significant difference between the two groups (3.5% bivalirudin vs. 7.0% heparin, P = 0.18). Patients with RAO had a significantly lower weight compared to patients without RAO (78 ± 13 kg vs. 86 ± 18 kg, P = 0.011). By multivariate analysis, a weight <84 kg (OR: 2.78, 95% CI 1.08-8.00, P = 0.032) and a procedure duration ≤20 min (OR: 7.52, 95% CI 1.57-36.0, P = 0.011) remained strong independent predictors of RAO. All cases of radial occlusion were asymptomatic and without clinical sequelae.


CONCLUSIONS
Delayed administration of bivalirudin or heparin for transradial catheterization provides similar efficacy in preventing RAO. Because of its low cost, a single bolus of heparin can be preferred in case of diagnostic angiography whereas bivalirudin can be contemplated in case of ad hoc percutaneous coronary intervention. © 2010 Wiley-Liss, Inc.
Plante
Sylvain
S
Southlake Regional Health Centre, Newmarket, Ontario, Canada. sylpla@rogers.com
Cantor
Warren J
WJ
Goldman
Lorne
L
Miner
Steven
S
Quesnelle
Amy
A
Ganapathy
Anusoumya
A
Popel
Abdol
A
Bertrand
Olivier F
OF
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D000925:Anticoagulants / Q000008:administration & dosage*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D017023:Coronary Angiography / Q000009:adverse effects*; D015150:Echocardiography, Doppler; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006629:Hirudins / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010092:Oximetry; D018579:Patient Selection; D010446:Peptide Fragments / Q000008:administration & dosage*; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects*; D011994:Recombinant Proteins / Q000008:administration & dosage; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin