Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: The results of the EVOLUTION-OFF study

Smedira, Nicholas G.; Dyke, Cornelius; Koster, Andreas; Jurmann, M.; Bhatia, Devinder; Hu, T. C.; McCarthy, Harry L.; Lincoff, A. Michael; Spiess, Bruce D.; Aronson, Solomon

doi:10.1016/j.jtcvs.2005.10.049

Cited by 83 publications

(50 citation statements)

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“…64,66,[75][76][77][78] Merry et al conducted a multicentre, randomized, unblinded pilot study enrolling 100 OPCAB patients to compare perioperative blood loss between those receiving bivalirudin (0.75 mgÁkg -1 bolus followed by 1.75 mgÁkg -1 Áhr -1 infusion) and those receiving UFH (150-300 UÁkg -1 ) with protamine reversal (1 mg:100 U UFH). 77 Median perioperative blood loss was similar; 793 mL for bivalirudin compared with 805 mL for UFH (interquartile range 320-4,909 mL vs 517-1,117 mL, respectively; P = 0.165).…”

Section: Bivalirudin Studies In the Cardiac Surgical Settingmentioning

confidence: 99%

“…75 The EVOLUTION-OFF study was a multicentre, randomized, unblinded, underpowered trial comparing UFH with protamine reversal to bivalirudin in OPCAB patients. 78 Bivalirudin was administered at a bolus dose of 0.75 mgÁkg -1 followed by a 1.75 mgÁkg -1 Áhr -1 infusion with the option to tailor therapy to a target ACT [ 300 sec. 78 Unfractionated heparin was administered on a weight-adjusted basis to a target ACT [ 300 sec with a mean protamine dose of 205 mg (range 15-450 mg).…”

mentioning

confidence: 99%

“…78 Bivalirudin was administered at a bolus dose of 0.75 mgÁkg -1 followed by a 1.75 mgÁkg -1 Áhr -1 infusion with the option to tailor therapy to a target ACT [ 300 sec. 78 Unfractionated heparin was administered on a weight-adjusted basis to a target ACT [ 300 sec with a mean protamine dose of 205 mg (range 15-450 mg). 78 The primary endpoint of a combined rate of freedom from death, Q-wave MI, repeat coronary revascularization, and stroke were similar for bivalirudin compared with UFH at day 7/discharge (96% bivalirudin vs 94.6% UFH combined endpoint incidence; 1/2/1/0 vs 1/0/1/2 for individual endpoint incidence, respectively), 30 days (93% bivalirudin vs 92.9% UFH, respectively; 2/2/3/0 vs 1/0/1/3, respectively), and 84 days (93% bivalirudin vs 92.9% UFH, respectively; 2/2/3/0 vs 1/0/1/3, respectively).…”

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confidence: 99%

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Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Bivalirudin use for anticoagulating patients undergoing cardiac surgery, particularly those with or at risk for heparin-induced thrombocytopenia, has expanded over the past several years. The purpose of this review is to provide a summary of the following: the differences between indirect and direct thrombin inhibition, unfractionated heparin's limitations (i.e., heparin-induced thrombocytopenia), bivalirudin's pharmacology, recent cardiac surgery trials comparing bivalirudin and unfractionated heparin as anticoagulants, the growing role of bivalirudin-mediated anticoagulation for various surgical procedures, and the potential of bivalirudin-mediated vascular graft patency.

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Section: Bivalirudin Studies In the Cardiac Surgical Settingmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Anand

Viles-González

Mahboobi

et al. 2010

Can J Anesth/J Can Anesth

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“…14 Similarly, argatroban has been used to facilitate CPB in patients with heparin-induced thrombocytopenia antibodies undergoing cardiac surgery. 15 Heparinbonded CPB circuits may have a role in reducing the need for systemic heparinization as well, however they are not used universally.…”

mentioning

confidence: 99%

“…Il s'agit d'un agent pouvant atteindre une anticoagulation efficace pour la CEC. 14 De même, l'argatroban a été utilisé pour faciliter la CEC chez les patients de chirurgie cardiaque présentant des anticorps en association avec une thrombocytopé-nie provoquée par l'héparine. 15 Les circuits de CEC enduits d'héparine pourraient jouer un rôle dans la réduction des besoins en héparinisation systémique; toutefois, ils ne sont pas utilisés universellement.…”

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Un autre cœur qui saigne: une réévaluation de l’anticoagulation á l’héparine

Harle

Murkin

2007

Can J Anesth/J Can Anesth

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HEPARIN anticoagulation titrated by prolongation of activated clotting time (ACT) continues to be a cornerstone of surgery employing cardiopulmonary bypass (CPB). Unfractionated heparin (UH) remains the standard anticoagulant used for extracorporeal circulation in the context of CPB, while low molecular weight heparin (LMWH) is increasingly used in the management of patients with unstable angina and in the prevention of venous thrombosis. We know that patients receiving UH preoperatively are at risk of demonstrating heparin resistance, or decreased heparin responsiveness, thus it does not come as a surprise that in this issue of the Journal, Bar-Yosef et al. present evidence that preoperative treatment with LMWH is also associated with decreased heparin responsiveness as measured by celite ACT. 1 And there's the rub --is there in actuality a lesser degree of anticoagulation, or does decreased heparin responsiveness in part reflect limitations in our current clinical measures of anticoagulation?Unfractionated heparin is a linear anionic sulphated glycosaminoglycan. It is a heterogeneous compound with variability in both the length and composition of the side chain carbohydrates which explains the range of its molecular weights (MW) from 3,000 to 30,000 Da. Low molecular weight heparin consists of short chain polysaccharides, with an average molecular weight of less than 8,000 Da. The plasma half-life of LMWH is considerably longer than (two to four times) that of UH, and is prolonged even further in renal failure. The critical high affinity binding site for antithrombin (AT) are comprised of unique sequences of pentasaccharide units which occur in only about one third of heparin chains and are randomly distributed. The primary anticoagulant effect of heparins is via activation of AT producing a heparin-antithrombin (H-AT) complex which inactivates thrombin, activated factor X (fXa) and other factors. Additionally, both UH and LMWH can be shown to have non-AT dependent anticoagulant properties via direct inhibition of 'intrinsic' tenase, a phospholipid bound complex of fVIIIa and fIXa which generates fXa. Extrinsic tenase, a complex of phospholipid bound tissue factor, fX and fVIIa, also generates fXa but is not inhibited by either UH or LMWH. 2 Other, non-AT-dependent anticoagulant activity is seen at high heparin concentrations wherein activation by large MW heparin of a second plasma protein, heparin co-factor II, impairs fXa generation. Such a heparin co-factor II-mediated anticoagulant effect of heparin could be operative in severe AT deficiency. 3 Large MW H-AT inhibits thrombin through a mechanism involving non-specific binding of thrombin coincident with high affinity binding of AT, whereas inhibition of fXa requires only high affinity binding of AT. 4 Small heparin fragments (< 18 saccharides) lack ability to simultaneously bind AT and thrombin, thus LMWH has limited antithrombin activity (insensitivity of ACT) but relatively potent anti-Xa activity (antithrombotic properties). As such, the anticoagulant ...

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Heparin-Induced Thrombocytopenia

Bartholomew

Immunogenicity of Biopharmaceuticals

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Anticoagulation with bivalirudin for off-pump coronary artery bypass grafting: The results of the EVOLUTION-OFF study

Cited by 83 publications

References 14 publications

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Utilisation de la bivalirudine en chirurgie cardiaque – de l’inhibition indirecte à l’inhibition directe de la thrombine

Un autre cœur qui saigne: une réévaluation de l’anticoagulation á l’héparine

Heparin-Induced Thrombocytopenia

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