title: Bivalirudin versus unfractionated heparin during peripheral vascular interventions: A Propensity-matched Study.
abstract: OBJECTIVE
  This study aimed to compare the association of access site complications and the use of unfractionated heparin versus bivalirudin during subinguinal peripheral vascular intervention.
  
  
  BACKGROUND
  Compared to unfractionated heparin, bivalirudin has been associated with fewer bleeding complications in patients undergoing percutaneous coronary intervention but more ischemic events. The safety and efficacy of direct thrombin inhibitors in peripheral vascular interventions is not well defined.
  
  
  METHODS
  We compared the incidence of in-hospital access site complications and discharge status among patients in the multicenter, prospective Vascular Quality Initiative registry who underwent peripheral vascular intervention between August 2007 and January 2014 using bivalirudin or unfractionated heparin. Propensity score matching was used to obtain a balanced cohort of 1,524 patients in each treatment group.
  
  
  RESULTS
  Patients treated with bivalirudin had a significantly lower incidence of access site hematomas (2.4% vs. 3.9%, P = 0.018), shorter post-procedural hospitalization (1.0 vs. 1.2 days, P < 0.001) and lower rates of discharge to a nursing home or rehabilitation center rather than home (7.61% vs. 9.73%, P = 0.034) when compared with unfractionated heparin-treated patients. The incidence of in-hospital access site occlusion, distal embolization, and mortality did not differ significantly between groups.
  
  
  CONCLUSIONS
  Patients who received bivalirudin had lower rates of access site hematoma, shorter length of stay, and improved discharge status compared with unfractionated heparin during hospitalization for peripheral vascular intervention. Randomized comparisons of these agents are needed to confirm these findings. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ortiz
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Maharaj
authors.initials: M
authors.lastname: Singh
authors.affiliation: Sheikh Khalifa Bin Hamad Al Thani Center for Integrative Research on Cardiovascular Aging, Aurora St. Luke's Medical Center, Milwaukee, Wisconsin.
authors.forename: Arshad
authors.initials: A
authors.lastname: Jahangir
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Suhail
authors.initials: S
authors.lastname: Allaqaband
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Jayant
authors.initials: J
authors.lastname: Khitha
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Tanvir K
authors.initials: TK
authors.lastname: Bajwa
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Mewissen
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D002170:Canada; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010351:Patient Discharge; D010446:Peptide Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D057216:Propensity Score; D011677:Punctures; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin
keywords: bivalirudin; hematoma; heparin; peripheral vascular intervention; pseudoaneurysm