title: Comparison of bivalirudin versus heparin on radial artery occlusion after transradial catheterization.
abstract: 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.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Ontario, Canada. sylpla@rogers.com
authors.forename: Sylvain
authors.initials: S
authors.lastname: Plante
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Lorne
authors.initials: L
authors.lastname: Goldman
authors.forename: Steven
authors.initials: S
authors.lastname: Miner
authors.forename: Amy
authors.initials: A
authors.lastname: Quesnelle
authors.forename: Anusoumya
authors.initials: A
authors.lastname: Ganapathy
authors.forename: Abdol
authors.initials: A
authors.lastname: Popel
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin