Brachytherapy and bivalirudin evaluation study
Am Heart J. 2005 Oct;150(4):832-7.
Pramod Kuchulakanti, MD, Roswitha Wolfram, MD, Rebecca Torguson, MS, Seung-Woon Rha, MD, Edouard Cheneau, MD, Ellen E. Pinnow, MS, Daniel Canos, MPH, Lowell F. Satler, MD, Augusto D. Pichard, MD, Kenneth M. Kent, MD, PhD, and Ron Waksman, MD Washington, DC
Background Bivalirudin is shown to be a competent substitute for heparin in percutaneous coronary intervention (PCI).
The safety and efficacy of bivalirudin in patients undergoing PCI and vascular brachytherapy (VBT) are not known. This study
aimed to assess the safety and efficacy of bivalirudin as a single antithrombotic agent in patients undergoing PCI and VBT.
Methods A total of 152 patients enrolled in the Brachytherapy and Bivalirudin Evaluation Study underwent PCI
and VBT with either gamma (n = 8) or h radiation (n = 144). The main outcome measures were in-hospital events and
30-day clinical outcomes. All patients were treated with bivalirudin (0.75 mg/kg bolus and 1.75 mg/kg per hour
infusion for h radiation, 1 mg/kg bolus and 2.5 mg/kg per hour infusion for gamma radiation) as a single
antithrombotic agent during the entire procedure.
Results Baseline clinical and angiographic characteristics were similar between the 2 groups. More than90%of the
patients received h radiation. In-hospital events showed a higher prevalence of acute procedural intracoronary thrombosis in
patients treated with gamma- vs h radiation (25% vs. 0.7%, P b .001). Thirty-day outcomes including death, Q-wave,
and non–Q-wave myocardial infarctions, subacute stent thromboses, and repeat revascularizations were similar in both groups.
Conclusion Bivalirudin, as a single antithrombotic agent during PCI and VBT with h emitters, may be used safely,
but its use in the setting of PCI and gamma radiation may not be acceptable due to an increased incidence of acute procedural
intracoronary thrombosis. (Am Heart J 2005;150:832-7.)
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