Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention

Sheikh, Imran; Ahmed, Salahuddin; Mori, Naoyo; Gupta, Anjan; Mewissen, Mark W.; Allaqaband, Suhail; Bajwa, Tanvir

doi:10.1016/j.jcin.2009.06.015

Cited by 23 publications

(25 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Additionally, use of heparin over bivalirudin (odds ratio 1.40, 95% CI 1.03-1.91) and nonuse of vascular closure device (odds ratio 1.74, 95% CI 1.49-2.02) were predictors of ASC. These observations concur with results from prior PVI studies, 5,9 the ACUITY trial 16 and an observational study based on the National Cardiovascular Data Registry®. 25 This shows that despite distinct populations, pathologies, procedures and bleeding definitions, bivalirudin is associated with reduced risk of bleeding complications compared to heparin while having the same efficacy in reducing thrombotic events.…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Access Site Complications After Peripheral Vascular Interventions

Ortiz

Jahangir

Singh

et al. 2014

Circ: Cardiovascular Interventions

Self Cite

103

View full text Add to dashboard Cite

Background Access site hematomas and pseudoaneurysms are the most frequent complications of peripheral vascular intervention (PVI); however, their incidence and risk factors remain unclear. Methods and Results We retrospectively analyzed data from the multicenter Vascular Quality Initiative® on 22,226 patients who underwent 27,048 PVI from August 2007 to May 2013. Primary endpoints included incidence and predictors of access site complications (ASC), length of postprocedural hospitalization, discharge status, and 30-day and 1-year mortality. ASC complicated 936 procedures (3.5%). Of these, 74.4% were minor complications, 9.7% were moderate requiring transfusion, 5.4% were moderate requiring thrombin injection, and 10.5% were severe requiring surgery. Predictors of ASC were age >75 years, female gender, white race, no prior PVI, nonfemoral arterial access site, >6-Fr sheath size, thrombolytics, arterial dissection, fluoroscopy time >30 minutes, nonuse of vascular closure device, bedridden preoperative ambulatory status, and urgent indication. Mean hospitalization was longer after procedures complicated by ASC (1.2 ± 1.6 days vs. 1.9 ± 1.9 days; range 0-7 days; p=0.002). Severity of ASC correlated with higher rates of discharge to rehabilitation/nursing facilities compared to home discharge. Patients with severe ASC had higher 30-day mortality (6.1% vs. 1.4%; p<0.001), and those with moderate ASC requiring transfusion had elevated 1-year mortality (12.1%, vs. 5.7%; p<0.001). Conclusions Several factors independently predict access site complication following peripheral vascular intervention. Appropriate use of antithrombotic therapies and vascular closure device in patients at increased risk of ASC may improve post-PVI outcomes.

show abstract

Section: Discussionsupporting

confidence: 90%

“…In comparison, access site complication occurred in 7.0% and 8.9% of patients in prior PVI studies. 5,6 The small sample sizes and difference in access site bleeding definitions used in the previous studies may account for the difference in complication rates.…”

Section: Discussionmentioning

confidence: 97%

Access Site Complications After Peripheral Vascular Interventions

Ortiz

Jahangir

Singh

et al. 2014

Circ: Cardiovascular Interventions

Self Cite

103

View full text Add to dashboard Cite

show abstract

“…18 Initial observational and single center studies have established the feasibility of bivalirudin in this setting and have suggested that clinical outcomes may be improved through reduction in bleeding. [19][20][21][22][23][24][25] In the absence of randomized data, our investigation represents the largest observational comparative analysis and proposes an association between bivalirudin and improved short-term outcomes after PVI. Evidence derived from comparative analyses in observational, nonrandomized data sets should always be interpreted with caution and only after robust statistical methods have been employed in an effort to account for baseline imbalances.…”

Section: Discussionmentioning

confidence: 99%

Bivalirudin Is Associated With Improved In-Hospital Outcomes Compared With Heparin in Percutaneous Vascular Interventions

Kimmelstiel

Pinto

Aronow

et al. 2016

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

Background— Peripheral vascular interventions are increasingly preferred for the treatment of patients with symptomatic peripheral arterial disease because they are associated with similar clinical outcomes and lower morbidity than open surgical procedures. The objective of this study was to assess the comparative effectiveness of procedural anticoagulation with bivalirudin compared with unfractionated heparin in patients undergoing peripheral vascular interventions. Methods and Results— This was a retrospective, observational study using the Premier Hospital administrative database. We examined 23 934 consecutive patients undergoing lower extremity peripheral vascular interventions between January 2008 and December 2012 who were treated with either bivalirudin or unfractionated heparin. In-hospital end points included death, myocardial infarction, transfusion, stroke, amputation, and the composite end points of major adverse cardiovascular events, and net adverse clinical events. Propensity score matching was performed to control for baseline imbalances and yielded 3649 matched pairs. After propensity score matching, patients treated with bivalirudin had lower in-hospital event rates with significantly lower mortality (odds ratio, 0.40; P =0.017), need for blood product transfusion (odds ratio, 0.74; P =0.009), major adverse cardiovascular events (odds ratio, 0.64; P =0.003), and net adverse clinical events (odds ratio, 0.72; P <0.001). These associations were observed consistently across clinically relevant subgroups. Conclusions— In patients undergoing peripheral vascular interventions, procedural anticoagulation with bivalirudin may result in more favorable in-hospital outcomes compared with unfractionated heparin, the current standard of care. These observations will require prospective confirmation in a randomized, controlled trial.

show abstract

“…A study evaluating prophylactic anticoagulation during peripheral intervention (with a heparin dose more closely approximating our protocol) found major and minor bleeding complications of 0.9% and 9.0%, respectively (26), but all complications were related to the arterial access site and therefore not applicable to our protocol, in which no arterial puncture was performed. In our patient group, no bleeding complications were reported.…”

Section: Safety Considerationsmentioning

confidence: 95%

Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in ¹⁸F-FDG PET Imaging

et al. 2015

View full text Add to dashboard Cite

Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention

Abstract: Low-dose UFH is as effective and safe as bivalirudin when used as an anticoagulation strategy in patients undergoing PPI, and low-dose UFH is less costly than bivalirudin. Larger randomized studies are required to further evaluate these findings.

Cited by 23 publications

References 13 publications

Access Site Complications After Peripheral Vascular Interventions

Access Site Complications After Peripheral Vascular Interventions

Bivalirudin Is Associated With Improved In-Hospital Outcomes Compared With Heparin in Percutaneous Vascular Interventions

Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in ¹⁸F-FDG PET Imaging

Contact Info

Product

Resources

About

Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention

Abstract: Low-dose UFH is as effective and safe as bivalirudin when used as an anticoagulation strategy in patients undergoing PPI, and low-dose UFH is less costly than bivalirudin. Larger randomized studies are required to further evaluate these findings.

Cited by 23 publications

References 13 publications

Access Site Complications After Peripheral Vascular Interventions

Access Site Complications After Peripheral Vascular Interventions

Bivalirudin Is Associated With Improved In-Hospital Outcomes Compared With Heparin in Percutaneous Vascular Interventions

Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in 18F-FDG PET Imaging

Contact Info

Product

Resources

About

Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in ¹⁸F-FDG PET Imaging