| Bivalirudin versus heparin and protamine in off-pump coronary artery bypass surgery. | |
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MedLine Citation:
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PMID: 14992900 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Bivalirudin is a short-acting direct thrombin inhibitor, with advantages over unfractionated heparin for anticoagulation in cardiac surgery. We hypothesized that bivalirudin is not associated with a clinically important increase in blood loss compared with heparin with protamine reversal in patients undergoing off pump coronary artery bypass (OPCAB) surgery. We also assessed flow with angiography at 3 months using a modified Thombolysis in Myocardial Infarction (TIMI) grade in the grafted coronary arteries. METHODS: One hundred patients were randomly assigned to receive bivalirudin (0.75 mg/kg bolus, 1.75 mg/kg/h infusion) or heparin (150 to 300 U/kg bolus) with protamine reversal. RESULTS: A median of 3 (range, 1 to 5) grafts were inserted per patient. Blood loss for the 12 hours after study drug initiation in the bivalirudin group (median, 793 mL; interquartile range, 532 to 1,214 mL; range, 320 to 4,909 mL; n = 50) was not significantly greater than in the heparin group (median, 805 mL; interquartile range, 517 to 1,117 mL; range, 201 to 2,567 mL; n = 50; p = 0.165). Median graft flow was 3.0 in the bivalirudin group (n = 40) and 2.67 in the heparin group (n = 39; p = 0.047). The bivalirudin group had more patients with grade 3 (ie, full) flow in at least 1 graft (100% versus 90%; p = 0.04), a trend toward more patients with grade 3 flow in all grafts (60% versus 38%; p = 0.06), and more grafts with grade 3 flow (82% versus 67%; p = 0.03). CONCLUSIONS: Anticoagulation for OPCAB surgery with bivalirudin was feasible without a clinically important increase in perioperative blood loss. Graft flow was better in the bivalirudin patients; the impact of this on clinical outcomes requires a larger study. |
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Authors:
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Alan F Merry; Peter J Raudkivi; Neil G Middleton; John M McDougall; Parma Nand; Brigid P Mills; Bruce J Webber; Chris M Frampton; Harvey D White |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 77 ISSN: 0003-4975 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2004 Mar |
Date Detail:
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Created Date: 2004-03-02 Completed Date: 2004-04-08 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: United States |
Other Details:
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Languages: eng Pagination: 925-31; discussion 931 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand. a.merry@auckland.ac.nz |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anticoagulants / administration & dosage* Antithrombins / administration & dosage, therapeutic use* Blood Loss, Surgical Coronary Artery Bypass / methods* Drug Therapy, Combination Female Heparin / administration & dosage* Heparin Antagonists / administration & dosage* Hirudins / administration & dosage, analogs & derivatives* Humans Male Middle Aged Peptide Fragments / administration & dosage, therapeutic use* Protamines / administration & dosage* Recombinant Proteins / administration & dosage, therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Antithrombins; 0/Heparin Antagonists; 0/Hirudins; 0/Peptide Fragments; 0/Protamines; 0/Recombinant Proteins; 128270-60-0/bivalirudin; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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