Comparison of Heparin and Bivalirudin in Patients Undergoing Orbital Atherectomy

• Published in: The Journal of invasive cardiology Vol. 29; no. 11; p. 397
• Main Authors: Lee, Michael S, Shlofmitz, Evan, Nayeri, Arash, Hollowed, John, Kong, Jeremy, Shlofmitz, Richard A
• Format: Journal Article
• Language: English
• Published: United States 01-11-2017
• Subjects: Aged; Aged, 80 and over; Antithrombins - administration & dosage; Atherectomy, Coronary - methods; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; Coronary Artery Disease - surgery; Coronary Vessels - diagnostic imaging; Coronary Vessels - surgery; Dose-Response Relationship, Drug; Female; Fibrinolytic Agents - administration & dosage; Heparin - administration & dosage; Hirudins - administration & dosage; Humans; Male; Peptide Fragments - administration & dosage; Recombinant Proteins - administration & dosage; Retrospective Studies; Vascular Calcification - diagnosis; Vascular Calcification - drug therapy; Vascular Calcification - surgery
• ISSN: 1557-2501

We compared the angiographic and clinical outcomes of heparin and bivalirudin in patients who underwent orbital atherectomy for severely calcified coronary lesions.
Severely calcified coronary lesions are associated with increased ischemic complications. Orbital atherectomy modifies calcified plaque, thereby facilitating stent delivery and stent expansion. The ideal antithrombotic agent during orbital atherectomy is unknown. Previous studies reported that bivalirudin was associated with lower bleeding rates compared with heparin plus glycoprotein IIb/IIa inhibitors during percutaneous coronary intervention.
This retrospective multicenter analysis included 458 consecutive real-world patients with severely calcified coronary arteries who underwent orbital atherectomy. Patients were stratified based on the antithrombotic agent that was used. The primary safety endpoint was the 30-day rate of major adverse cardiac and cerebrovascular events, defined as death, myocardial infarction, target-vessel revascularization, and stroke.
Heparin was used in 356/458 cases (77.2%) and bivalirudin was used in 102/458 cases (22.8%). The primary endpoint was similar in the heparin and bivalirudin groups (2% vs 3%; P=.55), as were the 30-day rates of death (1% vs 2%; P=.51), myocardial infarction (1% vs 1%; P=.90), target-vessel revascularization (0% vs 0%; P>.99), and stroke (0% vs 0%; P=.59). Angiographic complication, stent thrombosis, and major bleeding complication rates were similarly low in both groups.
Both heparin and bivalirudin were safe and effective antithrombotic agents for patients who underwent orbital atherectomy. A randomized trial is needed to determine the antithrombotic agent of choice for orbital atherectomy.