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The safety and efficacy of bivalirudin during percutaneous coronary intervention (PCI) in high bleeding risk patients with chronic total occlusion lesions (CTO) has not been studied. The use of bivalirudin may increase the thrombotic events during CTO-PCI.
Between May 2013 and April 2014, a total of 117 high bleeding risk patients with CTOs underwent PCI. Bivalirudin was used in 89 cases with different strategies, including standard usage, combination of heparin, and additional bolus of bivalirudin on the basis of standard usage. The clinical characteristics, procedural details and antithrombotic strategies were assessed.
The bleeding and ischemic events were evaluated. The first 7 of 9 patients with standard application of bivalirudin exhibited acute thrombogenesis in the procedure. Then, heparin was added in decreasing amounts in the next 8 patients and no thrombosis occurred, while 2 patients had bleeding complications. Then the following 72 patients were randomly assigned to heparin bolus or additional bivalirudin bolus group before we planned to do the percutaneous transluminal coronary angioplasty (PTCA). The baseline clinical characteristics and procedure information were identical in both groups. There was no ischemic and bleeding events occurred in both groups during the 6 months’ follow-up.
Monotherapy with bivalirudin in CTO-PCI should be treated with caution as the potential risk of thrombogenesis, which may be due to long procedure time, frequent change of equipment and temporary blood flow convection. Combination of heparin or an additional bolus of bivalirudin before PTCA was likely to decrease the incidence of thrombogenesis.