title: Bivalirudin versus unfractionated heparin for residual thrombus burden: a frequency-domain optical coherence tomography study.
abstract: OBJECTIVE
  This study aimed to compare the effect of bivalirudin and unfractionated heparin (UFH) on residual thrombus burden assessed by frequency-domain optical coherence tomography (FD-OCT), and on angiographic indices of microvascular obstruction (MVO).
  
  
  BACKGROUND
  The efficacy of bivalirudin to inhibit thrombus formation inside the stent during percutaneous coronary interventions (PCI) as compared to UFH is unknown.
  
  
  METHODS
  Sixty patients with coronary artery disease who underwent post-PCI FD-OCT were studied, including 20 patients treated with bivalirudin and 40 control patients treated with UFH, matched by clinical presentation, stent characteristics, and periprocedural medications. In-stent thrombus volume, thrombus score (number of quadrants with thrombus), and thrombus type (white/red) were assessed by FD-OCT. Thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), and Quantitative Blush Evaluator (QuBE) score were recorded.
  
  
  RESULTS
  Patients treated with bivalirudin showed similar thrombus volume (0.14 mm(3) [0.00-0.88] vs. 0.13 mm(3) [0.00-0.63], P = 0.962), thrombus score (10 [0-25] vs. 8 [0-21], P = 0.849) and thrombus length (1.70 mm [0.00-4.10] vs. 1.40 mm [0.00-4.05], P = 0.968], as compared with patients treated with UFH. Patients in the bivalirudin group showed lower proportion of white thrombus (55.5% vs. 78.6%, P = 0.016). There was no significant difference in TIMI flow grade, cTFC, and QuBE score between the two groups.
  
  
  CONCLUSIONS
  The present study showed similar residual thrombus burden and angiographic indices of MVO immediately after PCI between patients treated with bivalirudin and those treated with UFH.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.forename: Russell
authors.initials: R
authors.lastname: Joye
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.forename: Jinwei
authors.initials: J
authors.lastname: Tian
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.forename: James
authors.initials: J
authors.lastname: Chan
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Luigi Marzio
authors.initials: LM
authors.lastname: Biasucci
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000368:Aged; D018849:Controlled Clinical Trials as Topic; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006629:Hirudins; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: bivalirudin; optical coherence tomography; thrombus; unfractionated heparin